1184880734 NPI number — INSIGHT TREATMENT PROGRAM, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184880734 NPI number — INSIGHT TREATMENT PROGRAM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT TREATMENT PROGRAM, 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:
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:
1184880734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 E I65 SERVICE RD S
Provider Second Line Business Mailing Address:
SUITE A-7
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36606-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-473-6093
Provider Business Mailing Address Fax Number:
251-473-6469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE HILL
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36451-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-275-3036
Provider Business Practice Location Address Fax Number:
251-275-3721
Provider Enumeration Date:
08/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
251-473-6093

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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