1053918151 NPI number — THE SALVATION ARMY, A GEORGIA CORP. - MABEE CENTER

Table of content: (NPI 1053918151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053918151 NPI number — THE SALVATION ARMY, A GEORGIA CORP. - MABEE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SALVATION ARMY, A GEORGIA CORP. - MABEE CENTER
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:
1053918151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 E. LANCASTER AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76103-2123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-344-1831
Provider Business Mailing Address Fax Number:
817-338-9251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1855 E. LANCASTER AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76103-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-344-1831
Provider Business Practice Location Address Fax Number:
817-338-9251
Provider Enumeration Date:
10/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FLORES
Authorized Official First Name:
AUSTRUBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT TREASURER
Authorized Official Telephone Number:
404-728-1300

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 124732699 . This is a "UEIN (DUNS)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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