1164543138 NPI number — PASSAGES, INC.

Table of content: (NPI 1164543138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164543138 NPI number — PASSAGES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASSAGES, 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:
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:
1164543138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 N WALNUT ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
COLUMBIA CITY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46725-2066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-244-7688
Provider Business Mailing Address Fax Number:
260-244-7680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 N WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
COLUMBIA CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46725-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-244-7688
Provider Business Practice Location Address Fax Number:
260-244-7680
Provider Enumeration Date:
04/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FLECK
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
260-244-7688

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 315P00000X , with the licence number: 2660T0005DE08 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 315P00000X , with the licence number: 2660I0006DE08 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 315P00000X , with the licence number: 2660I0004DE08 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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