1013496264 NPI number — INTENTIONAL INTERVENTIONS, 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 1013496264 NPI number — INTENTIONAL INTERVENTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTENTIONAL INTERVENTIONS, 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:
1013496264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234-5796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-402-2720
Provider Business Mailing Address Fax Number:
609-788-3617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 S NEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANTVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08232-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-380-1122
Provider Business Practice Location Address Fax Number:
609-374-9166
Provider Enumeration Date:
08/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHENS
Authorized Official First Name:
TALIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER OPERATOR
Authorized Official Telephone Number:
609-402-2720

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-18-30938 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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