1700811668 NPI number — TENET HEALTHSYSTEM GRADUATE, LLC

Table of content: LESLIE PRATT M.A. CCC-SLP (NPI 1770824807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700811668 NPI number — TENET HEALTHSYSTEM GRADUATE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENET HEALTHSYSTEM GRADUATE, 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:
GRADUATE HOSPITAL
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:
1700811668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 828120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-8120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-255-3152
Provider Business Mailing Address Fax Number:
215-893-2302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 LOMBARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19146-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-893-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RABE
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
VP OF TAXATION, TENET HEALTHCARE
Authorized Official Telephone Number:
469-893-2530

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  073001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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