1457350803 NPI number — THERAPIES UNLIMITED, INC

Table of content: (NPI 1457350803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457350803 NPI number — THERAPIES UNLIMITED, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPIES UNLIMITED, 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:
1457350803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4386 STURBRIDGE DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110-3668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-540-3446
Provider Business Mailing Address Fax Number:
717-540-3447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4386 STURBRIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110-3668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-540-3446
Provider Business Practice Location Address Fax Number:
717-540-3447
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GAGNON
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-540-3446

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT008447L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TH1312977 . This is a "HIGHMARK BLUE SHIELD (ST)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01840050 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2584817 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02948200 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: TH862313 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1537903 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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