1639225113 NPI number — NATURE'S REFLECTIONS, LLC

Table of content: (NPI 1639225113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639225113 NPI number — NATURE'S REFLECTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATURE'S REFLECTIONS, LLC
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:
1639225113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1007 BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705-4143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-477-2728
Provider Business Mailing Address Fax Number:
919-477-3938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705-4143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-477-2728
Provider Business Practice Location Address Fax Number:
919-477-3938
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
QUANTA
Authorized Official Middle Name:
Authorized Official Title or Position:
HR DIRECTOR
Authorized Official Telephone Number:
919-477-2728

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8301329 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301329V , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3410182 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301329S , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301329H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008106 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301329B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5915112 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301329G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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