1609973569 NPI number — JOYCE MICHELE LENTZ

Table of content: (NPI 1609973569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609973569 NPI number — JOYCE MICHELE LENTZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOYCE MICHELE LENTZ
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:
SAGE HEALTHCARE LTD
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:
1609973569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6021 W CHEYENNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89108-4205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-396-1437
Provider Business Mailing Address Fax Number:
702-396-1443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6021 W CHEYENNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89108-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-396-1437
Provider Business Practice Location Address Fax Number:
702-396-1443
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LENTZ
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
MICHELE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-396-1437

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN28058 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: APN00352 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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