1154629897 NPI number — ARRIVE ALIVE

Table of content: (NPI 1154629897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154629897 NPI number — ARRIVE ALIVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARRIVE ALIVE
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:
PENNY MEDICINEBEAR
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:
1154629897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 433
Provider Second Line Business Mailing Address:
324 SUBSET AVE.
Provider Business Mailing Address City Name:
SMITHS GROVE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42171-0433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-784-7079
Provider Business Mailing Address Fax Number:
270-451-1200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 SUNSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHS GROVE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-784-7079
Provider Business Practice Location Address Fax Number:
270-451-1200
Provider Enumeration Date:
03/04/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEDICINEBEAR
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
270-784-7079

Provider Taxonomy Codes

  • Taxonomy code: 344600000X , with the licence number:  3586/ 3585 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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