1235304098 NPI number — ESCAPE A&D, LLC

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 1235304098 NPI number — ESCAPE A&D, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESCAPE A&D, 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:
ESCAPE OUTPATIENT CHEMICAL DEPENDENCY COUNSELING CENTER
Provider Other Organization Name Type Code:
4
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:
1235304098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 N AULT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBERLY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65270-2506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-263-7552
Provider Business Mailing Address Fax Number:
660-263-6593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N AULT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBERLY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65270-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-263-7552
Provider Business Practice Location Address Fax Number:
660-263-6593
Provider Enumeration Date:
04/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EAMES
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CEO PRIMARY THERAPIST
Authorized Official Telephone Number:
660-263-7552

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  1253-10266 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SATOP 066 . This is a "MO STATE CERTIFIED SUBSTANCE ABUSE TRAFFIC OFFENDER PROGRAMS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: MAC 501662 . This is a "NATIONAL ASSOCIATION OF ALCOHOL & DRUG ABUSE COUNSELORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: VENDOR 000613401 . This is a "MISSOURI DEPARTMENT OF SOCIAL SERVICES, CHILDRENS DIVISION" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CCCJS A11182 . This is a "AMERICAN COLLEGE OF CERTIFIED FORENSIC COUNSELORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: ICAADC 597 . This is a "THE INTERNATIONAL CERTIFICATION & RECIPROCITY CONSORTIUM / A & D ABUSE, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 1253-10266 . This is a "MO STATE CERTIFIED INTENMSIVE OUTPATIENT ALCOHOL & DRUG REHABILITATION CLINIC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: REACT R-319 . This is a "MO STATE CERTIFIED REQUIRED EDUCATIONAL ASSESSMENT AND COMMUNITY TREATMENT" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CASAC 542 . This is a "MISSOURI SUBSTANCE ABUSE PROFESSIONAL CREDENTIALING BOARD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com