1295912228 NPI number — RED APPLE NUTRITION, LLC

Table of content: (NPI 1295912228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295912228 NPI number — RED APPLE NUTRITION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RED APPLE NUTRITION, LLC
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:
1295912228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 MAPLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15086-7590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-814-0247
Provider Business Mailing Address Fax Number:
724-933-1916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 MAPLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15086-7590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-814-0247
Provider Business Practice Location Address Fax Number:
724-933-1916
Provider Enumeration Date:
01/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SINGER
Authorized Official First Name:
RITA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-814-0247

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 096137X3Y , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2005300 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".