1518272475 NPI number — THE RALEIGH BLACK CHAMBER OF COMMERCE

Table of content: MISS LOURDES BERNADETTE VERDERA POTESTADES PT, DPT, OCS (NPI 1053590125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518272475 NPI number — THE RALEIGH BLACK CHAMBER OF COMMERCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE RALEIGH BLACK CHAMBER OF COMMERCE
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:
1518272475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 91663
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-739-1113
Provider Business Mailing Address Fax Number:
888-738-1118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 BLUE RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-6479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-739-1113
Provider Business Practice Location Address Fax Number:
888-738-1118
Provider Enumeration Date:
08/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TRAINER
Authorized Official First Name:
D BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-739-1113

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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