1013181502 NPI number — ADVANCE THERAPY MENTAL HEALTH AND RECOVERY SERVICES LLC

Table of content: (NPI 1013181502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013181502 NPI number — ADVANCE THERAPY MENTAL HEALTH AND RECOVERY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE THERAPY MENTAL HEALTH AND RECOVERY SERVICES LLC
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:
ADVANCE THERAPY MENTAL HEALTH AND RECOVERY SERVICES LLC
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:
1013181502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 DOUGLAS ST STE 325
Provider Second Line Business Mailing Address:
BENSON BLDG
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51101-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-277-3200
Provider Business Mailing Address Fax Number:
712-277-3208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 DOUGLAS ST STE 325
Provider Second Line Business Practice Location Address:
BENSON BLDG
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51101-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-277-3200
Provider Business Practice Location Address Fax Number:
712-277-3208
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COAD
Authorized Official First Name:
BILL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
712-277-3200

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  01284 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2190223 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1041CO7004 . This is a "CLINICAL SOCIAL WORK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 80 . This is a "CMS CODE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com