1215265418 NPI number — ITS A PLAYFUL JOURNEY

Table of content: (NPI 1215265418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215265418 NPI number — ITS A PLAYFUL JOURNEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ITS A PLAYFUL JOURNEY
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:
1215265418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2173 EMBASSY DR
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17603-2387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-431-2027
Provider Business Mailing Address Fax Number:
717-431-2014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2173 EMBASSY DR
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17603-2387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-431-2027
Provider Business Practice Location Address Fax Number:
717-431-2014
Provider Enumeration Date:
11/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MATHIAS
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHILD, ADOLESCENT, FAMILY THERAPIST
Authorized Official Telephone Number:
717-431-2027

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1740305218 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1740305218 . This is a "EDUCATORS HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1740305218 . This is a "QUEST BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1740305218 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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