1396055125 NPI number — ZURCARE 007, LLC

Table of content: SHANTELL JEANETTE JOHNSON (NPI 1841901170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396055125 NPI number — ZURCARE 007, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZURCARE 007, 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:
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:
1396055125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3725 AIRPORT BLVD
Provider Second Line Business Mailing Address:
STE 100H
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-1633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-345-7337
Provider Business Mailing Address Fax Number:
251-345-7223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3725 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
STE 100H
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-345-7337
Provider Business Practice Location Address Fax Number:
251-345-7223
Provider Enumeration Date:
10/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
601-914-1004

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 900776 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 900776 . This is a "ALABAMA STATE BOARD OF PHARMACY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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