1568890127 NPI number — MOVING ON RECOVERY AND EDUCATION

Table of content: (NPI 1568890127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568890127 NPI number — MOVING ON RECOVERY AND EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOVING ON RECOVERY AND EDUCATION
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:
M.O.R.E.
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:
1568890127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 HARRIET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINONA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55987-3177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-454-2839
Provider Business Mailing Address Fax Number:
507-454-5864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 HARRIET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55987-3177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-454-2839
Provider Business Practice Location Address Fax Number:
507-454-5864
Provider Enumeration Date:
10/17/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NYBECK-GARCIA
Authorized Official First Name:
PATTI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
507-454-2839

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  10282204CDT , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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