1902665771 NPI number — BLACK EXCELLENCE STRIVING THERAPEUTIC

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 1902665771 NPI number — BLACK EXCELLENCE STRIVING THERAPEUTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACK EXCELLENCE STRIVING THERAPEUTIC
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:
1902665771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 771
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27528-0771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-879-6090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 SOUTHERN PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUDLEY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28333-9159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-879-6090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BEST
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
DEONTOINE
Authorized Official Title or Position:
QUALIFIED PROFESSIONAL
Authorized Official Telephone Number:
919-879-6090

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com