1811586977 NPI number — WINNING WHEELS, INC.

Table of content: (NPI 1811586977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811586977 NPI number — WINNING WHEELS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINNING WHEELS, 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:
1811586977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 6TH AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNDON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61261-7602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-778-3683
Provider Business Mailing Address Fax Number:
815-778-4503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 A ST APT 402
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROPHETSTOWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61277-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-778-3683
Provider Business Practice Location Address Fax Number:
815-778-4503
Provider Enumeration Date:
01/13/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LANDIS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
815-778-3683

Provider Taxonomy Codes

  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12 . This is a "HOMEMAKERS SERVICES" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com