1033448246 NPI number — S.T.E.P.S. DEVELOPMENT CENTER, LLC

Table of content: (NPI 1033448246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033448246 NPI number — S.T.E.P.S. DEVELOPMENT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S.T.E.P.S. DEVELOPMENT CENTER, 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:
FAMILY ADVANTAGE, LLC
Provider Other Organization Name Type Code:
5
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:
1033448246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
289 WADE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTLAND NECK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27874-8957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-326-0090
Provider Business Mailing Address Fax Number:
252-536-2322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE E.
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-4497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-326-0090
Provider Business Practice Location Address Fax Number:
252-536-2322
Provider Enumeration Date:
12/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GILCHRIST
Authorized Official First Name:
WILLIE
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
252-326-0090

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-070-047 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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