1225291958 NPI number — VENILIA GARDENS, INC

Table of content: (NPI 1225291958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225291958 NPI number — VENILIA GARDENS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VENILIA GARDENS, 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:
CULTURAL 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:
1225291958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 FIELD VIEW LN
Provider Second Line Business Mailing Address:
PO BOX 870
Provider Business Mailing Address City Name:
VINEYARD HAVEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02568-7607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-996-8800
Provider Business Mailing Address Fax Number:
508-996-8688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 FIELD VIEW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINEYARD HAVEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02568-7607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-996-8800
Provider Business Practice Location Address Fax Number:
508-996-8688
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PINA
Authorized Official First Name:
CELINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL ADMINISTRATOR
Authorized Official Telephone Number:
508-996-8800

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  259 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 0016381 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 160 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0137530 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000000024854 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018365033 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1892711 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LMG030 . This is a "BCBCMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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