1124013834 NPI number — MOBILECARE HEALTH SERVICE, LLC

Table of content: YORDANKA RODRIGUEZ REYES APRN (NPI 1700745114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124013834 NPI number — MOBILECARE HEALTH SERVICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILECARE HEALTH SERVICE, 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:
1124013834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2926B LEAPHART RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29169-3659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-926-2273
Provider Business Mailing Address Fax Number:
803-926-9490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2926B LEAPHART RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-3659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-926-2273
Provider Business Practice Location Address Fax Number:
803-926-9490
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TRENERY
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
803-926-2273

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  163 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AB0182 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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