1558605733 NPI number — MIND & REASON ADVOCACY GROUP, LLC.

Table of content: (NPI 1558605733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558605733 NPI number — MIND & REASON ADVOCACY GROUP, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIND & REASON ADVOCACY GROUP, 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:
1558605733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3511 LESLIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE HILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20748-4633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-246-6781
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2806 POMEROY RD SE
Provider Second Line Business Practice Location Address:
2808 POMEROY RD SE
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20020-5912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-246-6781
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ISOM
Authorized Official First Name:
DAVIAN
Authorized Official Middle Name:
NIKEITH
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
202-246-6781

Provider Taxonomy Codes

  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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