1134818362 NPI number — TIME 2 LAUNCH INC

Table of content: (NPI 1134818362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134818362 NPI number — TIME 2 LAUNCH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIME 2 LAUNCH 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:
MY TIME 2 LAUNCH
Provider Other Organization Name Type Code:
3
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:
1134818362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3832 SW 33RD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33023-5631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-707-3257
Provider Business Mailing Address Fax Number:
954-838-5358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3832 SW 33RD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33023-5631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-707-3257
Provider Business Practice Location Address Fax Number:
954-838-5358
Provider Enumeration Date:
05/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
PURCELL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT, CEO, CHIEF OPERATIONS
Authorized Official Telephone Number:
203-247-9453

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003245829A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103590400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023138100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119071500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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