1720326747 NPI number — REAL SKILLS ACADEMY, LLC

Table of content: (NPI 1720326747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720326747 NPI number — REAL SKILLS ACADEMY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REAL SKILLS ACADEMY, 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:
1720326747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4620 DIXIE HWY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48329-3574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-673-6799
Provider Business Mailing Address Fax Number:
248-209-6788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4620 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48329-3574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-673-6799
Provider Business Practice Location Address Fax Number:
248-209-6788
Provider Enumeration Date:
01/25/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUNCAN
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-673-6799

Provider Taxonomy Codes

  • Taxonomy code: 225XR0403X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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