1003092115 NPI number — GLOVE HOUSE, INC.

Table of content: (NPI 1003092115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003092115 NPI number — GLOVE HOUSE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLOVE HOUSE, 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:
1003092115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMIRA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14904-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-734-5238
Provider Business Mailing Address Fax Number:
607-737-0884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMIRA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14904-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-734-5238
Provider Business Practice Location Address Fax Number:
607-737-0884
Provider Enumeration Date:
01/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
J
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
MURPHY
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
607-734-5238

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  7468431 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01544201 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com