1366874216 NPI number — THE LUKENS INSTITUTE. LLC

Table of content: (NPI 1366874216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366874216 NPI number — THE LUKENS INSTITUTE. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LUKENS INSTITUTE. LLC
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:
1366874216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 101716
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91189-1716
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:
3587 SW CORPORATE PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-296-3507
Provider Business Practice Location Address Fax Number:
561-627-6077
Provider Enumeration Date:
08/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ROUSSEAU
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
772-266-7682

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 598378 . This is a "JOINT COMMISSION ACCREDITATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10D2059608 . This is a "CLIA WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1550AD019901 . This is a "DCF LICENSE- DAY/NIGHT, INTENSIVE OUTPATIENT & OUTPATIENT TREATMENT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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