1578834081 NPI number — RESURRECTION MINISTRIES

Table of content: (NPI 1578834081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578834081 NPI number — RESURRECTION MINISTRIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESURRECTION MINISTRIES
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:
COMPASSION IN ACTION BEHAVIORAL HEALTH
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:
1578834081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
553 CLINTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12206-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-689-0282
Provider Business Mailing Address Fax Number:
518-689-0283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
553 CLINTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12206-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-689-0282
Provider Business Practice Location Address Fax Number:
518-689-0283
Provider Enumeration Date:
01/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PAEGLOW
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
518-689-0282

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com