1710117239 NPI number — MIDVALLEY SENIORS,INC.

Table of content: MICHAEL ANTHONY LITTLE LMFTA (NPI 1235935461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710117239 NPI number — MIDVALLEY SENIORS,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDVALLEY SENIORS,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:
1710117239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11975 W MID VALLEY WAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WASILLA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99654-0634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-892-6114
Provider Business Mailing Address Fax Number:
907-892-7972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11975 W MID VALLEY WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WASILLA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99654-0634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-892-6114
Provider Business Practice Location Address Fax Number:
907-892-7972
Provider Enumeration Date:
07/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROUNDS
Authorized Official First Name:
LORIE
Authorized Official Middle Name:
RITA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
907-892-6114

Provider Taxonomy Codes

  • Taxonomy code: 332U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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