1356729586 NPI number — NEW GARY COMMUNITY DEVELOPMENT CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356729586 NPI number — NEW GARY COMMUNITY DEVELOPMENT CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW GARY COMMUNITY DEVELOPMENT CORP.
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:
6
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:
1356729586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4285 CLEVELAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46408-2429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-887-6418
Provider Business Mailing Address Fax Number:
219-887-2068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4285 CLEVELAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46408-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-887-6418
Provider Business Practice Location Address Fax Number:
219-887-2068
Provider Enumeration Date:
05/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
FAYE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
219-887-6418

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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