1316254543 NPI number — PREMIER LIVE-INS, INC.

Table of content: (NPI 1316254543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316254543 NPI number — PREMIER LIVE-INS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER LIVE-INS, 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:
1316254543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 HAMILTON AVE
Provider Second Line Business Mailing Address:
10TH FLOOR
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10601-1807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-428-7722
Provider Business Mailing Address Fax Number:
914-428-2404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W MAIN ST
Provider Second Line Business Practice Location Address:
BLDG. A, SUITE 5
Provider Business Practice Location Address City Name:
NORTHBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01532-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-393-8570
Provider Business Practice Location Address Fax Number:
508-393-8610
Provider Enumeration Date:
09/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TURCHAN
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
914-428-7722

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7246 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X , with the licence number: 7246 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7245 . This is a "LICENSE TO ESTABLISH AND CONDUCT AN EMPLOYMENT AGENCY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7247 . This is a "LICENSE TO ESTABLISH AND CONDUCT AN EMPLOYMENT AGENCY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7246 . This is a "LICENSE TO ESTABLISH AND CONDUCT AN EMPLOYMENT AGENCY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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