1952701112 NPI number — TEARS TEENS EMPOWERMENT AWARENESS WITH RESOLUTIONS, INC.

Table of content: (NPI 1952701112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952701112 NPI number — TEARS TEENS EMPOWERMENT AWARENESS WITH RESOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEARS TEENS EMPOWERMENT AWARENESS WITH RESOLUTIONS, 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:
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:
1952701112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 S RAILROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHENIX CITY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36867-6220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-291-6363
Provider Business Mailing Address Fax Number:
334-291-6399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 E OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSKEGEE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36083-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-226-1255
Provider Business Practice Location Address Fax Number:
334-727-1643
Provider Enumeration Date:
08/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WALTON
Authorized Official First Name:
ANGELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
334-291-6363

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  32025061 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106867 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1801045117 . This is a "NPI NUMBER FOR TEARS TEENS EMPOWERMENT AWARENESS WITH RESOLUTIONS, INC." identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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