1013496264 NPI number — INTENTIONAL INTERVENTIONS, LLC

Table of content: (NPI 1013496264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013496264 NPI number — INTENTIONAL INTERVENTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTENTIONAL INTERVENTIONS, 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:
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:
1013496264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234-5796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-402-2720
Provider Business Mailing Address Fax Number:
609-788-3617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 S NEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANTVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08232-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-380-1122
Provider Business Practice Location Address Fax Number:
609-374-9166
Provider Enumeration Date:
08/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHENS
Authorized Official First Name:
TALIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER OPERATOR
Authorized Official Telephone Number:
609-402-2720

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-18-30938 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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