1134436561 NPI number — SLC THERAPY

Table of content: (NPI 1134436561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134436561 NPI number — SLC THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLC THERAPY
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:
1134436561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36500 FORD RD
Provider Second Line Business Mailing Address:
#229
Provider Business Mailing Address City Name:
WESTLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48185-3769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-752-0899
Provider Business Mailing Address Fax Number:
203-604-0602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36500 FORD RD
Provider Second Line Business Practice Location Address:
#229
Provider Business Practice Location Address City Name:
WESTLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48185-3769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-752-0899
Provider Business Practice Location Address Fax Number:
203-604-0602
Provider Enumeration Date:
09/07/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEALS
Authorized Official First Name:
LANDRIA
Authorized Official Middle Name:
MONIQUE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
866-752-0899

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2355S0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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