1528404217 NPI number — A LIFE SAVER DBA PLEET HOME CARE AGENCY, INC.

Table of content: DR. WADE THOMAS KECKLER PSY.D. (NPI 1033447024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528404217 NPI number — A LIFE SAVER DBA PLEET HOME CARE AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A LIFE SAVER DBA PLEET HOME CARE AGENCY, 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:
1528404217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11222 ROCKAWAY BEACH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKAWAY PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11694-2313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-933-3932
Provider Business Mailing Address Fax Number:
718-559-6771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11222 ROCKAWAY BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKAWAY PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11694-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-933-3932
Provider Business Practice Location Address Fax Number:
718-559-6771
Provider Enumeration Date:
05/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
OIRING
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
646-933-3932

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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