1629495205 NPI number — R.O.C.K RIDE ON CENTER FOR KIDS

Table of content: (NPI 1629495205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629495205 NPI number — R.O.C.K RIDE ON CENTER FOR KIDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R.O.C.K RIDE ON CENTER FOR KIDS
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:
Provider Other Organization Name Type Code:
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:
1629495205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2422
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78627-2422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-930-7625
Provider Business Mailing Address Fax Number:
512-863-9231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 ROCKRIDE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-930-7625
Provider Business Practice Location Address Fax Number:
512-863-9231
Provider Enumeration Date:
03/21/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KRENCK
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
RIDE ON CENTER
Authorized Official Title or Position:
C.E.O
Authorized Official Telephone Number:
512-930-7625

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  642120000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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