1265255889 NPI number — VIRTUE IN SOLACE FOUNDATION CORP

Table of content: (NPI 1265255889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265255889 NPI number — VIRTUE IN SOLACE FOUNDATION CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRTUE IN SOLACE FOUNDATION CORP
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:
1265255889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 NORTH LOOP 1604 E
Provider Second Line Business Mailing Address:
STE #105 PMB 412
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
737-701-9087
Provider Business Mailing Address Fax Number:
830-837-5437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2218 TRUMANS HL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130-6684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
737-701-9087
Provider Business Practice Location Address Fax Number:
830-837-5437
Provider Enumeration Date:
11/04/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
ERIKKA
Authorized Official Middle Name:
LATREAL
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
737-701-9087

Provider Taxonomy Codes

  • Taxonomy code: 177F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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