1073838306 NPI number — A HUG AWAY II, INCORPORATED

Table of content: (NPI 1073838306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073838306 NPI number — A HUG AWAY II, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A HUG AWAY II, INCORPORATED
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:
A HUG AWAY HEALTH CARE, INCORPORATED
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:
1073838306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
956 DUNSTAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONE MOUNTAIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30083-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-228-2487
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21219 PARK ROYALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77450-4123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-868-4009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
PIERCE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
404-228-2487

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251F00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: RN184995 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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