1528263332 NPI number — RAMPART GROUP INC

Table of content: (NPI 1528263332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528263332 NPI number — RAMPART GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMPART GROUP 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:
SENIOR CARE OF BREVARD
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:
1528263332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 WILLARD STREET
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
COCOA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32922-7984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-631-9014
Provider Business Mailing Address Fax Number:
321-631-8010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 WILLARD ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COCOA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32922-7984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-631-9014
Provider Business Practice Location Address Fax Number:
321-631-8010
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUTCHINSON
Authorized Official First Name:
MARIANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
321-631-9014

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311500000X , with the licence number: 9030 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 675597600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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