1154454627 NPI number — NORTHEAST LEAD MANAGEMENT

Table of content: (NPI 1154454627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154454627 NPI number — NORTHEAST LEAD MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST LEAD MANAGEMENT
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:
1154454627
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:
PO BOX 40937
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02940-0937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-725-7922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-6121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-725-7922
Provider Business Practice Location Address Fax Number:
401-726-8834
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASSANI-BRANDT
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MASTER ENVIRONMENTAL LEAD INSPECTOR
Authorized Official Telephone Number:
401-725-7922

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  MLI-0018 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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