1548948755 NPI number — NEW HEIGHTS THERAPY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548948755 NPI number — NEW HEIGHTS THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HEIGHTS THERAPY 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:
1548948755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2145 WHITTINGHAM CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30075-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-695-2020
Provider Business Mailing Address Fax Number:
770-627-3240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4595 TOWNE LAKE PARKWAY
Provider Second Line Business Practice Location Address:
BUILDING 300 SUITE 250
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-695-2020
Provider Business Practice Location Address Fax Number:
770-627-3240
Provider Enumeration Date:
07/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
HANCOCK
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
770-695-2020

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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