1023338175 NPI number — HEALTHY PREFERRED INC

Table of content: (NPI 1023338175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023338175 NPI number — HEALTHY PREFERRED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY PREFERRED 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:
GENESIS GENETICS INSTITUTE
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:
1023338175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 W GLENOAKS BLVD
Provider Second Line Business Mailing Address:
STE 10 PMB 724
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91202-2896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-923-6566
Provider Business Mailing Address Fax Number:
888-922-5971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 CONNER ST
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48213-3448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-923-6566
Provider Business Practice Location Address Fax Number:
888-922-5971
Provider Enumeration Date:
06/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-923-6566

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  23D1036409 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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