1316694318 NPI number — TAKES A VILLAGE II

Table of content: (NPI 1316694318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316694318 NPI number — TAKES A VILLAGE II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAKES A VILLAGE II
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:
1316694318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1442
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPEWELL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23860-1442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13010 MORRIS RD STE 650
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30004-5197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-400-8839
Provider Business Practice Location Address Fax Number:
804-800-4483
Provider Enumeration Date:
03/09/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
LA-TOYA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/ CLINICIAN
Authorized Official Telephone Number:
804-404-8241

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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