1114083086 NPI number — APPLE PATCH COMMUNITY, INC.

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 1114083086 NPI number — APPLE PATCH COMMUNITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLE PATCH COMMUNITY, INC.
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:
1114083086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7408 HWY 329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-657-0103
Provider Business Mailing Address Fax Number:
502-657-0107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7416 HWY 329
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-657-0103
Provider Business Practice Location Address Fax Number:
502-657-0107
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPOELKER
Authorized Official First Name:
JOE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
502-657-0103

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  850067 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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