1124345319 NPI number — CROSSING PATHS, LLC

Table of content: DR. JULIE L. WETHERELL PH.D. (NPI 1417963273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124345319 NPI number — CROSSING PATHS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSING PATHS, 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:
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:
1124345319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
931 JEFFERSON BLVD
Provider Second Line Business Mailing Address:
SUITE 2001
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-2234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-921-3320
Provider Business Mailing Address Fax Number:
401-921-3327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S KINGS DR
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28204-2932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-333-9055
Provider Business Practice Location Address Fax Number:
704-333-9056
Provider Enumeration Date:
04/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MEDEIROS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
401-921-3320

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  1403 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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