1932633609 NPI number — ACCESS EVALUATION AND EDUCATION SERVICES, L.L.C.

Table of content: (NPI 1932633609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932633609 NPI number — ACCESS EVALUATION AND EDUCATION SERVICES, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS EVALUATION AND EDUCATION SERVICES, L.L.C.
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:
6
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:
1932633609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3640 CANTERBURY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50702-5705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-252-4631
Provider Business Mailing Address Fax Number:
181-421-2449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 CANTERBURY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50702-5705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-252-4631
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BONEBRAKE
Authorized Official First Name:
AMY
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OWNER/ DIRECTOR
Authorized Official Telephone Number:
319-252-4631

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 1401 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1316467061 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932633609 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073291902 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1316001845 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1356788616 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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