1861562886 NPI number — SACRED HEART HEALTH SYSTEM, 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 1861562886 NPI number — SACRED HEART HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACRED HEART HEALTH SYSTEM, 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:
WESTERN PANHANDLE EARLY STEPS
Provider Other Organization Name Type Code:
5
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:
1861562886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5045 CARPENTER CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32503-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-377-8802
Provider Business Mailing Address Fax Number:
888-249-2325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5045 CARPENTER CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32503-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-377-8802
Provider Business Practice Location Address Fax Number:
888-249-2325
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLS
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF EARLY INTERVENTION
Authorized Official Telephone Number:
850-377-8802

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 010076518 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010076521 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010076515 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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