1013056134 NPI number — ACADEMY FOR FAMILY EMPOWERMENT SERVICES, INC.

Table of content: (NPI 1013056134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013056134 NPI number — ACADEMY FOR FAMILY EMPOWERMENT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACADEMY FOR FAMILY EMPOWERMENT SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013056134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 MILSTEAD AVE NE
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
CONYERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30012-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-918-8003
Provider Business Mailing Address Fax Number:
770-918-8800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 MILSTEAD AVE NE
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30012-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-918-8003
Provider Business Practice Location Address Fax Number:
770-918-8800
Provider Enumeration Date:
02/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMMONS
Authorized Official First Name:
ADENISE
Authorized Official Middle Name:
GLEADIE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-918-8003

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)