1427424530 NPI number — DANCING GODDESS RISING MINISTRIES, 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 1427424530 NPI number — DANCING GODDESS RISING MINISTRIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANCING GODDESS RISING MINISTRIES, 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:
AWAKENING HEART WELLNESS SERVICES
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:
1427424530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 E 2ND STREET
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
RIVERHEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-426-2700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 E 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-4616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-426-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JULIANO
Authorized Official First Name:
JERRA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
516-426-2700

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  0829261 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com