1023227600 NPI number — AHEAD TO HEALTH, 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 1023227600 NPI number — AHEAD TO HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHEAD TO HEALTH, 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:
1023227600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15400 W CAPITOL DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53005-2661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-754-1211
Provider Business Mailing Address Fax Number:
262-754-2911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15400 W CAPITOL DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53005-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-754-1211
Provider Business Practice Location Address Fax Number:
262-754-2911
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEHNERT
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
262-754-1211

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2404 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 389207000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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