1295874527 NPI number — WOODBRIDGE ALTERNATIVE, INC

Table of content: (NPI 1295874527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295874527 NPI number — WOODBRIDGE ALTERNATIVE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODBRIDGE ALTERNATIVE, 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:
1295874527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1480 PAMALEE DRIIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28303-3928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-488-9570
Provider Business Mailing Address Fax Number:
910-822-0111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1480 PAMALEE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28303-3928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-488-9570
Provider Business Practice Location Address Fax Number:
910-822-0111
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
LEON
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
910-488-9570

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026718 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026705 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026680 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL065161 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL065155 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026477 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026464 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026707 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026454 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL009019 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026557 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL026618 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: MHL024052 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6603588 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603284 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603733 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603283 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301341B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005215 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005216 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603044 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603046 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603282 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603589 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301341H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603603 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301341G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603045 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603136 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603233 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6603325 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301341 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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