1598751000 NPI number — AFFILIATED THERAPY SERVICES, LLC

Table of content: (NPI 1598751000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598751000 NPI number — AFFILIATED THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATED THERAPY SERVICES, 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:
AFFILIATED THERAPY SERVICES, INC
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:
1598751000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4050 E COTTON CENTER BLVD STE 18
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85040-8862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-653-8190
Provider Business Mailing Address Fax Number:
602-296-5622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 ROBIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-5751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-542-7878
Provider Business Practice Location Address Fax Number:
985-542-4396
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DIPAOLA
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
303-859-7474

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42561 . This is a "BLUE CROSS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1677485 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 640001 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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