1528435419 NPI number — THE THERAPEUTIC PLAY FOUNDATION INC.

Table of content: (NPI 1528435419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528435419 NPI number — THE THERAPEUTIC PLAY FOUNDATION INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE THERAPEUTIC PLAY FOUNDATION 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:
BLACK MENTAL HEALTH TASK FORCE
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:
1528435419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 SOUTH LAKE AVE # 236
Provider Second Line Business Mailing Address:
SUITE 236
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-924-9084
Provider Business Mailing Address Fax Number:
626-313-3453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 WEST MOUNTAIN AVENUE
Provider Second Line Business Practice Location Address:
UNIT 103
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-924-9084
Provider Business Practice Location Address Fax Number:
626-313-3453
Provider Enumeration Date:
08/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
NAKEYA
Authorized Official Middle Name:
TONISHA
Authorized Official Title or Position:
FOUNDER/PRESIDENT
Authorized Official Telephone Number:
323-924-9084

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  25754 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 25754 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 25754 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CB253110 . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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