1073893939 NPI number — TRADEWINDS ENRICHMENT SOLUTIONS, INC

Table of content: (NPI 1073893939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073893939 NPI number — TRADEWINDS ENRICHMENT SOLUTIONS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRADEWINDS ENRICHMENT SOLUTIONS, 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:
ADAP COUNSELING SERVICES
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:
1073893939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
959 SE CENTRAL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34994-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-286-8933
Provider Business Mailing Address Fax Number:
772-286-8970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
959 SE CENTRAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-286-8933
Provider Business Practice Location Address Fax Number:
772-286-8970
Provider Enumeration Date:
08/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TOUGAS
Authorized Official First Name:
PIERRE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
772-286-8933

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  111123 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 1943AD811200 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111123 . This is a "DCF - BATTERERS INTERVENTION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1943AD811200 . This is a "DCF LICENSE NUMBER - SUBSTANCE ABUSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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