1063586527 NPI number — SEEDS OF HOPE, LLC

Table of content: (NPI 1063586527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063586527 NPI number — SEEDS OF HOPE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEEDS OF HOPE, 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:
1063586527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 93262
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30377-0262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-753-6569
Provider Business Mailing Address Fax Number:
404-755-6731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
581 GARDEN WALK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30349-6675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-753-6569
Provider Business Practice Location Address Fax Number:
404-755-6731
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ASOMAH
Authorized Official First Name:
PAULETTE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER / CHIEF ADMINISTRATOR
Authorized Official Telephone Number:
404-753-6569

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000720101AL , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101AT , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101AX , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101AS , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101AN , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101S , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101W , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101AO , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101AY , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101AH , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000720101BB , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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