1821127440 NPI number — DREW CORPORATION

Table of content: (NPI 1821127440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821127440 NPI number — DREW CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DREW 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:
MOULTRIE COUNTY COMMUNITY CENTER
Provider Other Organization Name Type Code:
3
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:
1821127440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2576 N GREENWAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRO GORDO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61818-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-763-2191
Provider Business Mailing Address Fax Number:
217-763-2101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 E. STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-873-5266
Provider Business Practice Location Address Fax Number:
217-873-6266
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBUS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
217-763-2191

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  26112 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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