1619088135 NPI number — MOBILE HEALTH RESOURCES, LLC

Table of content: (NPI 1619088135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619088135 NPI number — MOBILE HEALTH RESOURCES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE HEALTH RESOURCES, 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:
1619088135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48901-8246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-318-3800
Provider Business Mailing Address Fax Number:
517-318-0338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48906-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-318-3800
Provider Business Practice Location Address Fax Number:
517-318-0338
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEBHARD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
517-318-3800

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PREFERRED CHOICES . This is a "PREF CHOICES PROVIDER ID#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AB630013 . This is a "MCARE PROVIDER ID NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 124405 . This is a "CARE CHOICES PROVIDER ID#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AB630016 . This is a "MCARE PROVIDER ID NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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