1831956069 NPI number — CONNECT N CARE ABA VA LLC

Table of content: (NPI 1831956069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831956069 NPI number — CONNECT N CARE ABA VA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECT N CARE ABA VA LLC
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:
1831956069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1072 MADISON AVE STE 625
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-2650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-262-2221
Provider Business Mailing Address Fax Number:
877-745-4345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8609 WESTWOOD CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYSONS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22182-7521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-262-2221
Provider Business Practice Location Address Fax Number:
877-745-4345
Provider Enumeration Date:
03/04/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORZEL
Authorized Official First Name:
F
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
704-412-1132

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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