1255649364 NPI number — ATTENTION & SENSORY-MOTOR DEVELOPMENT, LLC

Table of content: (NPI 1255649364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255649364 NPI number — ATTENTION & SENSORY-MOTOR DEVELOPMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATTENTION & SENSORY-MOTOR DEVELOPMENT, 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:
1255649364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1336 W SUNSET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99323-8601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-845-3810
Provider Business Mailing Address Fax Number:
888-881-3559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8514 W GAGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-8108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-845-3810
Provider Business Practice Location Address Fax Number:
888-881-3559
Provider Enumeration Date:
09/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEY
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
509-845-3810

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  OT00001974 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 876733SPE . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1987486 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1558530949 . This is a "OREGON DHS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 5114KE . This is a "ASURIS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9863141 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8519530 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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