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

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 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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