1245286822 NPI number — NINTH STREET HEALTH CARE ASSOCIATES LLC

Table of content: (NPI 1245286822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245286822 NPI number — NINTH STREET HEALTH CARE ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NINTH STREET HEALTH CARE ASSOCIATES LLC
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:
6
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:
1245286822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 9TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34102-8135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-261-8126
Provider Business Mailing Address Fax Number:
239-261-8647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 9TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-8135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-261-8126
Provider Business Practice Location Address Fax Number:
239-261-8647
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
CHRISSANDA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
239-261-8126

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  SNF1224096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 025228000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com