1336282862 NPI number — ASSURED RESOURCE ENVIRONMENT

Table of content: (NPI 1336282862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336282862 NPI number — ASSURED RESOURCE ENVIRONMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSURED RESOURCE ENVIRONMENT
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.R.E.
Provider Other Organization Name Type Code:
5
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:
1336282862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1816 MIDDLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28052-7626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-864-1389
Provider Business Mailing Address Fax Number:
704-563-8113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1816 MIDDLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28052-7626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-864-1389
Provider Business Practice Location Address Fax Number:
704-563-8113
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
OWNER PROGRAM DIRECTOR
Authorized Official Telephone Number:
704-605-4531

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  MHL-036-227 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6603936 . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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