1447447354 NPI number — EDUCATION PLAYSTATION, INC.

Table of content: (NPI 1447447354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447447354 NPI number — EDUCATION PLAYSTATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDUCATION PLAYSTATION, INC.
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:
1447447354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 SUMMER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADAIRSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30103-2956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-877-9105
Provider Business Mailing Address Fax Number:
770-877-9106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 SUMMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADAIRSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30103-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-877-9105
Provider Business Practice Location Address Fax Number:
770-877-9106
Provider Enumeration Date:
09/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MINGONE
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
770-877-9105

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X , with the licence number:  11-6874 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X , with the licence number: 11-6874 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 012454464B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000708463E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 478159310B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 385626610C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".