1528227147 NPI number — EPIC HEALTH SERVICES, INC.

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 1528227147 NPI number — EPIC HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPIC HEALTH SERVICES, 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:
AVEANNA HEATLHCARE
Provider Other Organization Name Type Code:
3
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:
1528227147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 INTERSTATE NORTH PKWY SE STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-464-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17480 N. DALLAS PKWY
Provider Second Line Business Practice Location Address:
SUITE 221
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75287-7337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-623-5900
Provider Business Practice Location Address Fax Number:
214-623-5901
Provider Enumeration Date:
06/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DRAKE
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF LEGAL OFFICER
Authorized Official Telephone Number:
470-464-8000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  012032 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 12032-LICENSEDHCSSA , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 015029 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 194507301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com