1134410327 NPI number — POSITIVE PROGRESS SERVICES CORP.

Table of content: JACQUELINE ALCANTARA (NPI 1265218952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134410327 NPI number — POSITIVE PROGRESS SERVICES CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE PROGRESS SERVICES CORP.
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:
1134410327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 E 3RD ST STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28372-7991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-521-7461
Provider Business Mailing Address Fax Number:
910-521-7463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 E 3RD ST
Provider Second Line Business Practice Location Address:
SUITE #5
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-7991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-521-7461
Provider Business Practice Location Address Fax Number:
910-521-7463
Provider Enumeration Date:
04/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMONDS
Authorized Official First Name:
LORIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
910-521-7461

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MHL-078-249 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1477604007 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063618049 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1770689101 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134225154 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760607006 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com