1396075156 NPI number — PEOPLE OF COLOR NETWORK

Table of content: LEIGH SCHEURITZEL L.C.S.W (NPI 1649604752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396075156 NPI number — PEOPLE OF COLOR NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEOPLE OF COLOR NETWORK
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:
1396075156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 E THOMAS RD
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-3115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-253-3084
Provider Business Mailing Address Fax Number:
602-253-3732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4520 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 555 AND 565
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-253-3084
Provider Business Practice Location Address Fax Number:
602-265-3280
Provider Enumeration Date:
12/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEON
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
TOMAS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-253-3084

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: BH3494 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 485908 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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