1225005887 NPI number — L & D ENTERPRISES, INC.

Table of content: (NPI 1225005887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225005887 NPI number — L & D ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L & D ENTERPRISES, 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:
PRAIRIE 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:
1225005887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1460 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
SUN PRAIRIE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53590-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-837-4814
Provider Business Mailing Address Fax Number:
608-825-4933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SUN PRAIRIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53590-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-837-4814
Provider Business Practice Location Address Fax Number:
608-825-4933
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBARD
Authorized Official First Name:
CATHRYN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
608-837-4814

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1742 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 1742 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103G00000X , with the licence number: 1742 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1742 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 42-183800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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