1720573215 NPI number — TOOLS4LIFE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720573215 NPI number — TOOLS4LIFE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOOLS4LIFE 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:
TOOLS4LIFE LLC
Provider Other Organization Name Type Code:
4
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:
1720573215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 HOLLY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHPORT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28461-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-366-2946
Provider Business Mailing Address Fax Number:
910-363-4075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 E. 8TH STREET
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
SOUTHPORT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28461-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-987-6491
Provider Business Practice Location Address Fax Number:
910-363-4075
Provider Enumeration Date:
06/27/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HEDGECOCK
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
OWNER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
910-987-6491

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6104503 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com