1669956223 NPI number — RITE OF PASSAGE INC

Table of content: (NPI 1669956223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669956223 NPI number — RITE OF PASSAGE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RITE OF PASSAGE 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:
1669956223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2560 BUSINESS PKWY STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINDEN
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89423-8961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-392-2657
Provider Business Mailing Address Fax Number:
775-392-2455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3304 E I 80 SERVICE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82009-8781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-829-7355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
RUSTY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
BUSINESS MANAGING DIRECTOR
Authorized Official Telephone Number:
775-392-2639

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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