1417278169 NPI number — THOMPSON CHILD AND FAMILY FOCUS

Table of content: (NPI 1417278169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417278169 NPI number — THOMPSON CHILD AND FAMILY FOCUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMPSON CHILD AND FAMILY FOCUS
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:
YORK PLACE
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:
1417278169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6800 SAINT PETER'S LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28105-7185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-536-0375
Provider Business Mailing Address Fax Number:
704-531-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
852 GOLD HILL ROAD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
FORT MILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29708-6965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-548-4044
Provider Business Practice Location Address Fax Number:
803-548-4074
Provider Enumeration Date:
06/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PORRAS KANTROWITZ
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
ACCOUNTS RECEIVABLE
Authorized Official Telephone Number:
704-536-0375

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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