1306338215 NPI number — DOUGLAS CO AND UNINCORPORATED TOWNS

Table of content: (NPI 1306338215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306338215 NPI number — DOUGLAS CO AND UNINCORPORATED TOWNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS CO AND UNINCORPORATED TOWNS
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:
CHINA SPRING YOUTH CAMP
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:
1306338215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINDEN
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89423-0218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-265-5350
Provider Business Mailing Address Fax Number:
775-265-7159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 CHINA SPRING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDNERVILLE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-265-5350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GARRISON
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
COLLEEN
Authorized Official Title or Position:
DIRECTOR OF JUVENILE CAMP SERVICES
Authorized Official Telephone Number:
775-265-5350

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  8954-PRTF-0 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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