1639240971 NPI number — DEPAUL COMMUNITY RESOURCES

Table of content: (NPI 1639240971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639240971 NPI number — DEPAUL COMMUNITY RESOURCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPAUL COMMUNITY RESOURCES
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:
DEPAUL FAMILY SERVICES
Provider Other Organization Name Type Code:
4
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:
1639240971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5650 HOLLINS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24019-5056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-265-8923
Provider Business Mailing Address Fax Number:
540-206-1007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5650 HOLLINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24019-5056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-265-8923
Provider Business Practice Location Address Fax Number:
540-265-5849
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
540-265-8923

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 02302006 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 02301001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 02303001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 02303002 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 02305001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 02308001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 02309001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 02310001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 372600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004947215 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010050197 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010050391 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010050413 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010050383 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004945930 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010050359 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010050430 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010050367 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004947509 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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