1407125156 NPI number — INTERNATIONAL PENTECOSTAL ASSY. ECUM. (IPAE)

Table of content: (NPI 1407125156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407125156 NPI number — INTERNATIONAL PENTECOSTAL ASSY. ECUM. (IPAE)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNATIONAL PENTECOSTAL ASSY. ECUM. (IPAE)
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:
Provider Other Organization Name Type Code:
6
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:
1407125156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
283 E 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60411-2837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-758-1840
Provider Business Mailing Address Fax Number:
708-758-1845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 E STEGER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEGER
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60475-6017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-358-5353
Provider Business Practice Location Address Fax Number:
708-758-1845
Provider Enumeration Date:
12/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
708-758-1840

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: DCN:005115 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com