1104141563 NPI number — HEALING THERAPEUTICS, LLC

Table of content: (NPI 1104141563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104141563 NPI number — HEALING THERAPEUTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING THERAPEUTICS, 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:
1104141563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12133 N 127TH WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85259-3425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-686-1818
Provider Business Mailing Address Fax Number:
480-264-7481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21803 N SCOTTSDALE RD
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85255-7438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-585-4673
Provider Business Practice Location Address Fax Number:
480-264-7481
Provider Enumeration Date:
03/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MENG
Authorized Official First Name:
LESLEY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-686-1818

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  35043 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 088377 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com