1376893842 NPI number — IN LOVING ARMS LLC

Table of content: (NPI 1376893842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376893842 NPI number — IN LOVING ARMS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN LOVING ARMS 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:
1376893842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 SIEBENKITTEL CIRCLE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARRIERE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39426-8778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-907-4117
Provider Business Mailing Address Fax Number:
601-510-9431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 WHITE CHAPEL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARRIERE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39426-8778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-907-4117
Provider Business Practice Location Address Fax Number:
601-510-9431
Provider Enumeration Date:
09/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
AUGUSTUS
Authorized Official First Name:
MARVENE
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER/CEO
Authorized Official Telephone Number:
225-907-4117

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  0000 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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