1518130848 NPI number — TEEN PREGNANCY PREVENTION INTERVENTION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518130848 NPI number — TEEN PREGNANCY PREVENTION INTERVENTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEEN PREGNANCY PREVENTION INTERVENTION
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:
1518130848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 W BROADWAY
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-2130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-587-5001
Provider Business Mailing Address Fax Number:
502-587-5005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 W BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-5001
Provider Business Practice Location Address Fax Number:
502-587-5005
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
NORAINE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
502-587-5001

Provider Taxonomy Codes

  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50005253 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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