1679759310 NPI number — THERAPEUTIC ENTERPRISES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679759310 NPI number — THERAPEUTIC ENTERPRISES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC ENTERPRISES 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:
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:
1679759310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 OLD SAWMILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06281-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-963-0712
Provider Business Mailing Address Fax Number:
860-963-0712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 ROUTE 169
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-963-0712
Provider Business Practice Location Address Fax Number:
860-963-0712
Provider Enumeration Date:
01/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
NOREEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-963-0712

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  000442 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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