1972054989 NPI number — HOLIDAY AL NIC MANAGEMENT LLC

Table of content: (NPI 1972054989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972054989 NPI number — HOLIDAY AL NIC MANAGEMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLIDAY AL NIC MANAGEMENT LLC
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:
HOLIDAY RETIREMENT
Provider Other Organization Name Type Code:
3
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:
1972054989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5885 MEADOWS RD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035-8639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-245-8020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5885 MEADOWS RD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
LAKE OSWEGO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97035-8639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-245-8020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PARALEGAL FOR MANAGEMENT COMPANY
Authorized Official Telephone Number:
971-245-8020

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009421900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009507900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009793200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009793400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009788900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009091600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009789900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009794200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805631 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009023200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009678900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009790400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7805634 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009196100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009794700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009792400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com