1427612175 NPI number — RICHLAND COUNSELING CENTER LLC

Table of content: (NPI 1427612175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427612175 NPI number — RICHLAND COUNSELING CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHLAND COUNSELING CENTER 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:
Provider Other Organization Name Type Code:
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:
1427612175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUAKERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18951-0049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-643-3011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 APPLE ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUAKERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18951-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-858-1674
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TUCKER
Authorized Official First Name:
ANN
Authorized Official Middle Name:
BREVOORT
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
215-643-3011

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1043388762 . This is a "ANN B TUCKER NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 488136000 . This is a "IBX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5386083 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PS-008240-L . This is a "PA LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1664450 . This is a "BEACON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 247500000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".