1679814792 NPI number — TIME FOR HEALING, LLC

Table of content: (NPI 1679814792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679814792 NPI number — TIME FOR HEALING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIME FOR HEALING, 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:
1679814792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 CAMPBELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-937-5290
Provider Business Mailing Address Fax Number:
610-626-8032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
349 LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HAVERFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19041-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-937-5290
Provider Business Practice Location Address Fax Number:
610-626-8032
Provider Enumeration Date:
03/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KAHN-FREEDMAN
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
610-937-5290

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 198702 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com