1710493143 NPI number — NEW CONCEPTS FOR CHANGE

Table of content: (NPI 1710493143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710493143 NPI number — NEW CONCEPTS FOR CHANGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW CONCEPTS FOR CHANGE
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:
NEW CONCEPTS
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:
1710493143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 WABASH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47807-3325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-235-8744
Provider Business Mailing Address Fax Number:
812-282-7258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 WABASH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47807-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-235-8744
Provider Business Practice Location Address Fax Number:
812-282-7258
Provider Enumeration Date:
12/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEPELEA
Authorized Official First Name:
KIMBERLI
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
812-235-8744

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  87001381A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 34006237A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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