1578608303 NPI number — ENRICHMENT CENTER INC.

Table of content: (NPI 1578608303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578608303 NPI number — ENRICHMENT CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENRICHMENT CENTER 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:
1578608303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2035 VAN WYE ST SE - P.O. BOX 2357
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44484-5349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-369-2137
Provider Business Mailing Address Fax Number:
330-369-1144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2035 VAN WYE ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44484-5349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-369-2137
Provider Business Practice Location Address Fax Number:
330-369-1144
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WESLEY
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
330-369-2137

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  7810935 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0415429 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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