1487936449 NPI number — FLORENCE CRITTENTON HOME

Table of content: AL JUN ALBA RN (NPI 1689021560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487936449 NPI number — FLORENCE CRITTENTON HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORENCE CRITTENTON HOME
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:
1487936449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
519 W FOURTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40508-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-252-8636
Provider Business Mailing Address Fax Number:
859-252-5546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 W FOURTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40508-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-252-8636
Provider Business Practice Location Address Fax Number:
859-252-5546
Provider Enumeration Date:
09/15/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CONNOR
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST/PROGRAM DIRECTOR
Authorized Official Telephone Number:
859-252-8636

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  500066 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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