1184081952 NPI number — A STEP AHEAD, LLC

Table of content: (NPI 1184081952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184081952 NPI number — A STEP AHEAD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A STEP AHEAD, 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:
A STEP AHEAD, LLC
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:
1184081952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 THOMPSON LN
Provider Second Line Business Mailing Address:
STE 115
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37204-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-383-0048
Provider Business Mailing Address Fax Number:
615-383-1588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1703 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401-3517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-383-0048
Provider Business Practice Location Address Fax Number:
615-383-1588
Provider Enumeration Date:
01/25/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIEGER
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
MATHEW
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
615-383-0048

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  ORT0000000184 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1519384 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83035 . This is a "NORTHWOOD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1256593 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: ASTE6255-0000 . This is a "LINKIA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 002366979501 . This is a "UNITED HEALTH CARE COMMUNITY PLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".