1740505494 NPI number — GENIE'S SPEECH THERAPY SEVICES

Table of content: (NPI 1740505494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740505494 NPI number — GENIE'S SPEECH THERAPY SEVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENIE'S SPEECH THERAPY SEVICES
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:
1740505494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 EGRET POINT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNEADS FERRY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28460-9464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-233-9721
Provider Business Mailing Address Fax Number:
866-519-5072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 EGRET POINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNEADS FERRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28460-9464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-233-9721
Provider Business Practice Location Address Fax Number:
866-519-5072
Provider Enumeration Date:
04/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
LADONNA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER, SPEECH PATHOLOGIST
Authorized Official Telephone Number:
910-233-9721

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  5244 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7412703 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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