1639419070 NPI number — MOREJOYTHERAPY SERVICES,LLC

Table of content: (NPI 1639419070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639419070 NPI number — MOREJOYTHERAPY SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOREJOYTHERAPY 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:
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:
1639419070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3581
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75606-3581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-331-6001
Provider Business Mailing Address Fax Number:
903-663-5580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N SPUR 63
Provider Second Line Business Practice Location Address:
SUITE B-3
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75601-5013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-690-1486
Provider Business Practice Location Address Fax Number:
903-663-5580
Provider Enumeration Date:
02/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MORELAND
Authorized Official First Name:
JOY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
903-690-1486

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  210352 , 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)





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