1164061628 NPI number — IBERO AMERICAN ACTION LUEAGE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164061628 NPI number — IBERO AMERICAN ACTION LUEAGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IBERO AMERICAN ACTION LUEAGE, INC.
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:
1164061628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
817 EAST MAIN STREET
Provider Second Line Business Mailing Address:
SAME
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14605-5144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-256-8900
Provider Business Mailing Address Fax Number:
585-544-8608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
817 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
SAME
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14605-5144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-256-8900
Provider Business Practice Location Address Fax Number:
585-544-8608
Provider Enumeration Date:
01/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MARIN
Authorized Official First Name:
GRISELL
Authorized Official Middle Name:
Authorized Official Title or Position:
HCBS DIRECTOR
Authorized Official Telephone Number:
585-256-8900

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com