1013081215 NPI number — HALIFAX HEALTH SERVICES, LLC.

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 1013081215 NPI number — HALIFAX HEALTH SERVICES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALIFAX HEALTH SERVICES, 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:
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:
1013081215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 W MULBERRY ST
Provider Second Line Business Mailing Address:
SUITE 102 ATTN MECCA
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-220-2074
Provider Business Mailing Address Fax Number:
888-504-4171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 W GRANADA BLVD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-8157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-872-4700
Provider Business Practice Location Address Fax Number:
888-504-4171
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ-DOTY
Authorized Official First Name:
DENA
Authorized Official Middle Name:
Authorized Official Title or Position:
AO
Authorized Official Telephone Number:
972-201-3819

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299992196 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 014860300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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