1942324884 NPI number — PERSONAL DEVELOPMENT CENTER, INC.

Table of content: (NPI 1942324884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942324884 NPI number — PERSONAL DEVELOPMENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONAL DEVELOPMENT CENTER, 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:
PERSONAL GROWTH AND LEARNING 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:
1942324884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 N CEDAR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-520-8435
Provider Business Mailing Address Fax Number:
931-372-7225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 N CEDAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-520-8435
Provider Business Practice Location Address Fax Number:
931-372-7225
Provider Enumeration Date:
03/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOVELL
Authorized Official First Name:
CAROLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
931-520-8435

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 9660 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3708402 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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