1861895450 NPI number — PARTNERS IN POSITIVE SOBRIETY, PC

Table of content: (NPI 1861895450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861895450 NPI number — PARTNERS IN POSITIVE SOBRIETY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS IN POSITIVE SOBRIETY, PC
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:
1861895450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 WINDY RIDGE PARKWAY,
Provider Second Line Business Mailing Address:
SUITE 210 SOUTH
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-642-7230
Provider Business Mailing Address Fax Number:
312-642-7055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 N LAKE SHORE DR
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-642-7230
Provider Business Practice Location Address Fax Number:
312-642-7055
Provider Enumeration Date:
09/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
TYEAST
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR RCM
Authorized Official Telephone Number:
678-813-0428

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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