1508803214 NPI number — MINDPATH CARE CENTERS, NORTH CAROLINA, PLLC

Table of content: (NPI 1508803214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508803214 NPI number — MINDPATH CARE CENTERS, NORTH CAROLINA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINDPATH CARE CENTERS, NORTH CAROLINA, PLLC
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:
MINDPATH HEALTH, A PRACTICE OF, MINDPATH CARE CENTERS, NORTH CAROLINA,
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:
1508803214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3835 N FREEWAY BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95834-1954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-576-7900
Provider Business Mailing Address Fax Number:
916-277-9380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3610 BUSH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-7511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-792-3938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPAULDING
Authorized Official First Name:
JASMINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PAYOR RELATIONS SUPERVISOR
Authorized Official Telephone Number:
916-567-7893

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com