1336329614 NPI number — MILESTONES TREATMENT & LEARNING CENTER, INC

Table of content: (NPI 1336329614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336329614 NPI number — MILESTONES TREATMENT & LEARNING CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILESTONES TREATMENT & LEARNING CENTER, 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:
1336329614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 CHERRY ST STE 50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27105-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-659-0806
Provider Business Mailing Address Fax Number:
336-659-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 CHERRY ST STE 50
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27105-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-659-0806
Provider Business Practice Location Address Fax Number:
336-659-1054
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CUMBO
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
SOLOMON
Authorized Official Title or Position:
SPEECH PATHOLOGIST/OWNER
Authorized Official Telephone Number:
336-659-0806

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 829 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7211967 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: E2524 . This is a "MEDCOST DR ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 694621 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7426450 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9340223 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: B1272 . This is a "MEDCOST PRACTICE ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 26450 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 51047116 . This is a "TRICARE PROVIDER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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