1144488099 NPI number — WELLINGTON ESTATES INC

Table of content: (NPI 1144488099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144488099 NPI number — WELLINGTON ESTATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLINGTON ESTATES 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:
1144488099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44090-0386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-647-2088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 WEBER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-647-2088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WEBER
Authorized Official First Name:
ADELBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
440-647-2088

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36-G658 . This is a "CMS CERTIFICATION NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4710085 . This is a "ODMR/DD FACILITY NO." identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 12480 . This is a "MR/DD LICENSE NO." identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0067898 . This is a "OHIO MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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