1528674819 NPI number — FLOURISHING ROOTS THERAPY LLC

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 1528674819 NPI number — FLOURISHING ROOTS THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLOURISHING ROOTS THERAPY LLC
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:
1528674819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 WHITE PINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06488-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-923-5078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 SHERMAN HILL RD, BUILDING A
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06798-0679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-364-4069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SCHERTZER
Authorized Official First Name:
FLOREN
Authorized Official Middle Name:
Authorized Official Title or Position:
SOCIAL WORKER/OWNER
Authorized Official Telephone Number:
203-923-5078

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008078864 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com