1801378112 NPI number — KOKORO HEALTH & WELLNESS INC.

Table of content: (NPI 1801378112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801378112 NPI number — KOKORO HEALTH & WELLNESS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOKORO HEALTH & WELLNESS 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:
KOKORO
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:
1801378112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14850 MONTFORT DR STE 181
Provider Second Line Business Mailing Address:
LB 11
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-431-5656
Provider Business Mailing Address Fax Number:
214-446-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14850 MONTFORT DR STE 181
Provider Second Line Business Practice Location Address:
LB 11
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75254-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-431-5656
Provider Business Practice Location Address Fax Number:
214-446-6010
Provider Enumeration Date:
09/04/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
ADRIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
469-463-3353

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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