1669898284 NPI number — FLEX CARE, LLC

Table of content: (NPI 1669898284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669898284 NPI number — FLEX CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLEX CARE, 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:
FLEX REHAB
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:
1669898284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 SHERMAN POTTS DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
GHENT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12075-3216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-965-6099
Provider Business Mailing Address Fax Number:
518-822-0776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SHERMAN POTTS DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
GHENT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12075-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-965-6099
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLDER
Authorized Official First Name:
IJUNANYA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/PHYSICAL THERAPIST
Authorized Official Telephone Number:
518-965-6099

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  028416 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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