1992938120 NPI number — POSITIVE INNOVATED BEGINNINGS, LLC

Table of content: ASHLEY PENDLETON GAINES MD (NPI 1811967771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992938120 NPI number — POSITIVE INNOVATED BEGINNINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE INNOVATED BEGINNINGS, 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:
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:
1992938120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 PARK CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27104-3840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-602-9597
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 S MARSHALL ST
Provider Second Line Business Practice Location Address:
SUITE 2-6
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27101-5852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-602-9597
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PITTS
Authorized Official First Name:
LATRICIA
Authorized Official Middle Name:
TANKSLEY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-602-9597

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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