1235311515 NPI number — ASTEP ABOVE THE REST MENTAL HEALTH SERVICES

Table of content: (NPI 1235311515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235311515 NPI number — ASTEP ABOVE THE REST MENTAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASTEP ABOVE THE REST MENTAL HEALTH SERVICES
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:
1235311515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 313
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28034-0313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-851-9588
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1562 UNION RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-2210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-851-9588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BANKS
Authorized Official First Name:
CHARLENE
Authorized Official Middle Name:
LIMKO
Authorized Official Title or Position:
CEO/PROGRAM DIRECTOR
Authorized Official Telephone Number:
828-851-9588

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  302530 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: 302530 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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