1356341234 NPI number — TALLAHASSE CARE, INC

Table of content: (NPI 1356341234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356341234 NPI number — TALLAHASSE CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALLAHASSE CARE, 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:
THE PINES REHABILITATION & HEALTH CARE CENTER
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:
1356341234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 TAFT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-5664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-966-6741
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 ARMSTRONG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48911-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-393-5680
Provider Business Practice Location Address Fax Number:
517-393-8311
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
YONI
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
732-237-4829

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  334110 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: 334110 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3013942 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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