1609904341 NPI number — THERAPY 4 KIDS, LLC

Table of content: (NPI 1609904341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609904341 NPI number — THERAPY 4 KIDS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY 4 KIDS, 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:
1609904341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9685 MAIN ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-3752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-978-8400
Provider Business Mailing Address Fax Number:
703-978-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9685 MAIN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-978-8400
Provider Business Practice Location Address Fax Number:
703-978-9898
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHER
Authorized Official First Name:
LORNA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
703-978-8400

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  2305202398 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X , with the licence number: 0119002945 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 2202003923 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 192066 . This is a "ANTHEM BCBS OT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 192067 . This is a "ANTHEM BCBS SPEECH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 192064 . This is a "ANTHEM BCBS PT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3429217 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7347554 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 696852 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: G663 . This is a "CARE FIRST BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com