1790060747 NPI number — EMBRACIVE HEALTH SERVICES, INC.

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 1790060747 NPI number — EMBRACIVE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBRACIVE HEALTH SERVICES, 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:
1790060747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7565
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST THOMAS
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00801-0565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-437-7589
Provider Business Mailing Address Fax Number:
888-505-5087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8203 LINDBERG BAY DRIVE
Provider Second Line Business Practice Location Address:
CYRIL E. KING AIRPORT
Provider Business Practice Location Address City Name:
ST. THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802-5945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-437-7589
Provider Business Practice Location Address Fax Number:
888-505-5087
Provider Enumeration Date:
10/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
EVELYN
Authorized Official First Name:
LISLE
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT/ CEO
Authorized Official Telephone Number:
866-437-7589

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  1-13182-1L , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com