1063401750 NPI number — KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT

Table of content: (NPI 1063401750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063401750 NPI number — KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT
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:
STONEHENGE OF SPRINGVILLE
Provider Other Organization Name Type Code:
3
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:
1063401750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 WEST 450 SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGVILLE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-960-9000
Provider Business Mailing Address Fax Number:
801-607-2318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 WEST 450 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-960-9000
Provider Business Practice Location Address Fax Number:
801-607-2318
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROBISON
Authorized Official First Name:
CORY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
801-358-7625

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2005-NCF-89 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 870440524019 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com