1184236721 NPI number — MISS OCTOBER JONES CNA

Table of content: MISS OCTOBER JONES CNA (NPI 1184236721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184236721 NPI number — MISS OCTOBER JONES CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
OCTOBER
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNA
Provider Gender Code:
F

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:
1184236721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1870
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELL CITY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35125-5870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-239-8852
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HANDS OVER HEARTS LLC
Provider Second Line Business Practice Location Address:
1025 23RD STREET SOUTH -387
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-239-8852
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2020

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: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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