1144880626 NPI number — ELIAS O DECKER QMHS - BACHELOR'S

Table of content: ELIAS O DECKER QMHS - BACHELOR'S (NPI 1144880626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144880626 NPI number — ELIAS O DECKER QMHS - BACHELOR'S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECKER
Provider First Name:
ELIAS
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
QMHS - BACHELOR'S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DECKER
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144880626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 CROSS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44311-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-253-9388
Provider Business Mailing Address Fax Number:
330-376-6726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 CROSS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44311-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-253-9388
Provider Business Practice Location Address Fax Number:
330-376-6726
Provider Enumeration Date:
06/18/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: C.2406291 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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