1811904394 NPI number — WHITNEY ACADEMY, INC.

Table of content: (NPI 1811904394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811904394 NPI number — WHITNEY ACADEMY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITNEY ACADEMY, 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:
1811904394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 619
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
E. FREETOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-763-3737
Provider Business Mailing Address Fax Number:
508-763-4200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 DR. BRALEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E. FREETOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-763-3737
Provider Business Practice Location Address Fax Number:
508-763-4200
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'KEEFE
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
508-763-3737

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  1475569 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: 1475569 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 114923900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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