1255569547 NPI number — ROLANDO AMADOR

Table of content: (NPI 1255569547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255569547 NPI number — ROLANDO AMADOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROLANDO AMADOR
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:
AMADOR FOSTER HOME
Provider Other Organization Name Type Code:
3
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:
1255569547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 MARSHVIEW WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARPSWELL
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04079-3356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-833-6219
Provider Business Mailing Address Fax Number:
207-833-2964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 MARSHVIEW WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARPSWELL
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04079-3356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-833-6219
Provider Business Practice Location Address Fax Number:
207-833-2964
Provider Enumeration Date:
06/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AMADOR
Authorized Official First Name:
ROLANDO
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
207-833-6219

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  ALLS2892 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 128810000 . This is a "MEDICARE BILLING NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com