1619088135 NPI number — MOBILE HEALTH RESOURCES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619088135 NPI number — MOBILE HEALTH RESOURCES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE HEALTH RESOURCES, 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:
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:
1619088135
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:
PO BOX 18246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48901-8246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-318-3800
Provider Business Mailing Address Fax Number:
517-318-0338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48906-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-318-3800
Provider Business Practice Location Address Fax Number:
517-318-0338
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEBHARD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
517-318-3800

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PREFERRED CHOICES . This is a "PREF CHOICES PROVIDER ID#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AB630013 . This is a "MCARE PROVIDER ID NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 124405 . This is a "CARE CHOICES PROVIDER ID#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AB630016 . This is a "MCARE PROVIDER ID NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com