1588241467 NPI number — TAYLORED LIFE CARE

Table of content: (NPI 1588241467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588241467 NPI number — TAYLORED LIFE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLORED LIFE CARE
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:
1588241467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 NEAL ST UNIT 3589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26103-4032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-916-2593
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MOOREFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-916-2593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SHOCKEY
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
APRN
Authorized Official Telephone Number:
304-893-7000

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1679706469 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com