1225655707 NPI number — SASHA MONTREZ PAGE SOCIAL WORKER

Table of content: SASHA MONTREZ PAGE SOCIAL WORKER (NPI 1225655707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225655707 NPI number — SASHA MONTREZ PAGE SOCIAL WORKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGE
Provider First Name:
SASHA
Provider Middle Name:
MONTREZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SOCIAL WORKER
Provider Gender Code:
F

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:
1225655707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1955 POPPS FERRY RD # 1064
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILOXI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39532-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-999-4154
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W VETERANS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79720-5566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-263-7631
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  M9681 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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