1871658120 NPI number — ALBERTA PROFESSIONAL SERVICES, INC.

Table of content: (NPI 1871658120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871658120 NPI number — ALBERTA PROFESSIONAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBERTA PROFESSIONAL SERVICES, 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:
1871658120
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:
1000 REVOLUTION MILL DR
Provider Second Line Business Mailing Address:
STUDIO 2
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-273-2640
Provider Business Mailing Address Fax Number:
336-273-6522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 REVOLUTION MILL DR
Provider Second Line Business Practice Location Address:
STUDIO 2
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-5042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-273-2640
Provider Business Practice Location Address Fax Number:
336-273-6522
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
336-273-2640

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251C00000X , with the licence number: MHL-041-768 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-041-553 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-041-125 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-041-152 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-041-229 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-041-068 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-041-164 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 322D00000X , with the licence number: MHL-034-108 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 3418317 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603001 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603018 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603016 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603140 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603533 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603003 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301821B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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