1790817674 NPI number — TRICO CORPORATION

Table of content: ANNA STRICKLAND WEAVER BCBA (NPI 1437738036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790817674 NPI number — TRICO CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRICO CORPORATION
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:
1790817674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 826
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-862-4966
Provider Business Mailing Address Fax Number:
301-862-5554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2670 CRAIN HIGHWAY, SUITE 525
Provider Second Line Business Practice Location Address:
SMALLWOOD BUILDING
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-632-2100
Provider Business Practice Location Address Fax Number:
301-632-2150
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARICK
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-862-4966

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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