1326110487 NPI number — MR. COLE M GILL MSW

Table of content: KENDA GENE BEEBE (NPI 1558114579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326110487 NPI number — MR. COLE M GILL MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILL
Provider First Name:
COLE
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

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:
1326110487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 FRIEND STREET
Provider Second Line Business Mailing Address:
ELEMENT CARE INC
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-715-6608
Provider Business Mailing Address Fax Number:
781-715-6699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 FRIEND ST
Provider Second Line Business Practice Location Address:
ELEMENT CARE INC
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-581-7565
Provider Business Practice Location Address Fax Number:
617-474-0757
Provider Enumeration Date:
11/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 214261 . This is a "STATE LICENSE #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".