1760700751 NPI number — TCP NUTRITION MANAGEMENT, INC.

Table of content: PETER SHEA WARD MHC (NPI 1013358464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760700751 NPI number — TCP NUTRITION MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TCP NUTRITION MANAGEMENT, 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:
1760700751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2225 LAKESIDE DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24501-6750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-238-0900
Provider Business Mailing Address Fax Number:
434-316-6115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 LAKESIDE DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24501-6750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-238-0900
Provider Business Practice Location Address Fax Number:
434-316-6115
Provider Enumeration Date:
05/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
CARTER
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
434-238-0900

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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