1588961882 NPI number — EXCEPTIONAL CARE WITHIN

Table of content: (NPI 1588961882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588961882 NPI number — EXCEPTIONAL CARE WITHIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEPTIONAL CARE WITHIN
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:
1588961882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3494 HEATH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELTONA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32725-3097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-520-1792
Provider Business Mailing Address Fax Number:
386-218-4036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3494 HEATH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTONA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32725-3097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-520-1792
Provider Business Practice Location Address Fax Number:
386-218-4036
Provider Enumeration Date:
02/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
YVONNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-520-1792

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 373H00000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 372500000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3747A0650X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 385HR2065X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251S00000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3747P1801X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 376J00000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 385H00000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 372600000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 385HR2060X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 385HR2055X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251C00000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 347C00000X , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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