1609144682 NPI number — THIRTEEN LAC, INC.

Table of content: (NPI 1609144682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609144682 NPI number — THIRTEEN LAC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THIRTEEN LAC, 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:
1609144682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2058
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-770-9930
Provider Business Mailing Address Fax Number:
410-779-9338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8523 THACKERY ST
Provider Second Line Business Practice Location Address:
STE 324
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-916-9058
Provider Business Practice Location Address Fax Number:
214-265-5995
Provider Enumeration Date:
12/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MAINGUY
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-770-9930

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  11457 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com