1659632107 NPI number — CLARINDA YOUTH CORPORATION

Table of content: PAULO ENRIQUE PARRA RUBIO (NPI 1659191377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659632107 NPI number — CLARINDA YOUTH CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARINDA YOUTH CORPORATION
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:
6
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:
1659632107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIVE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50325-0602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-243-2057
Provider Business Mailing Address Fax Number:
515-244-5570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 N 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARINDA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51632-1165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-542-3103
Provider Business Practice Location Address Fax Number:
712-542-6145
Provider Enumeration Date:
05/31/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
712-542-3103

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  08601 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 29423 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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