1346470135 NPI number — SEASHORE POINT WELLNESS AND REHAB

Table of content: (NPI 1346470135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346470135 NPI number — SEASHORE POINT WELLNESS AND REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEASHORE POINT WELLNESS AND REHAB
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:
SEASHORE POINT
Provider Other Organization Name Type Code:
4
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:
1346470135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ALDEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVINCETOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02657-1456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-487-7777
Provider Business Mailing Address Fax Number:
508-487-7706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ALDEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVINCETOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02657-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-487-7777
Provider Business Practice Location Address Fax Number:
508-487-7706
Provider Enumeration Date:
07/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MONTMINY
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
REHAB MANAGER
Authorized Official Telephone Number:
508-487-7777

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  11096 , 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: 1106 . This is a "MA STATE LIC NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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