1982739462 NPI number — EMBRACE US, INC,

Table of content: (NPI 1982739462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982739462 NPI number — EMBRACE US, INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBRACE US, 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:
1982739462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5603 DAVID CHRISTIAN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27410-1930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-254-1805
Provider Business Mailing Address Fax Number:
336-547-3968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3719 W MARKET ST
Provider Second Line Business Practice Location Address:
STE. C.
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27403-1588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-254-1805
Provider Business Practice Location Address Fax Number:
336-547-3968
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRADER
Authorized Official First Name:
CONTESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-254-1805

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3362541805CS . This is a "COMM.SPT. PHNE." identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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