1275299828 NPI number — N'PERFECT BALANCE, INC

Table of content: (NPI 1275299828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275299828 NPI number — N'PERFECT BALANCE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N'PERFECT BALANCE, INC
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:
1275299828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3568 HABERSHAM AT NORTHLAKE ROAD
Provider Second Line Business Mailing Address:
BLDG.K
Provider Business Mailing Address City Name:
TUCKER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-585-2300
Provider Business Mailing Address Fax Number:
770-302-0892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3568 HABERSHAM AT NORTHLAKE ROAD
Provider Second Line Business Practice Location Address:
BLDG.K
Provider Business Practice Location Address City Name:
TUCKER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-585-2300
Provider Business Practice Location Address Fax Number:
770-302-0892
Provider Enumeration Date:
11/09/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TRIMBLE
Authorized Official First Name:
SHANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
678-585-2300

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MFT001743 . This is a "GA LICENSE BOARD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".