1598391963 NPI number — ROHRBACH SERVICES FOR FAMILIES

Table of content: (NPI 1598391963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598391963 NPI number — ROHRBACH SERVICES FOR FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROHRBACH SERVICES FOR FAMILIES
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:
ROHRBACH SERVICES FOR FAMILIES
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:
1598391963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
471 S FLINT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLIVAR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65613-2159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-619-1595
Provider Business Mailing Address Fax Number:
417-777-0180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 E BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLIVAR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65613-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-619-1595
Provider Business Practice Location Address Fax Number:
417-777-0180
Provider Enumeration Date:
03/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ROHRBACH
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
417-619-1595

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 490040398 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com