1518041037 NPI number — ARCHWAY ENTERPRISES, INC.

Table of content: (NPI 1518041037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518041037 NPI number — ARCHWAY ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCHWAY ENTERPRISES, INC.
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:
1518041037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 ANGELO LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCOA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32931-3601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-953-3225
Provider Business Mailing Address Fax Number:
321-953-3252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-953-3225
Provider Business Practice Location Address Fax Number:
321-953-3252
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINSON-SAVAGE
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-953-3225

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH0005906 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CAQH #11566536 . This is a "PROVIDER INSURANCE #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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