1538441829 NPI number — PENNY HOLVEY LSW

Table of content: PENNY HOLVEY LSW (NPI 1538441829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538441829 NPI number — PENNY HOLVEY LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLVEY
Provider First Name:
PENNY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

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:
1538441829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 S PORTAGE PATH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44320-2327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-253-4597
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 S PORTAGE PATH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44320-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-253-4597
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  S007654 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9277202 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".