1144665092 NPI number — NAZCARE, INC - AMBITION WELLNESS CENTER

Table of content: (NPI 1144665092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144665092 NPI number — NAZCARE, INC - AMBITION WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAZCARE, INC - AMBITION WELLNESS CENTER
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:
1144665092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
599 WHITE SPAR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86303-4627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-442-9505
Provider Business Mailing Address Fax Number:
602-535-3230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 W DESMOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSLOW
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86047-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-442-9205
Provider Business Practice Location Address Fax Number:
602-535-3230
Provider Enumeration Date:
05/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
928-442-9205

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com