1689151201 NPI number — EPISCOPAL HEALTH SERVICES INC

Table of content: ASHLEE CILLESSEN SLP (NPI 1114204245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689151201 NPI number — EPISCOPAL HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPISCOPAL HEALTH SERVICES INC
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:
6
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:
1689151201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 S POLK ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79101-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-242-7782
Provider Business Mailing Address Fax Number:
718-362-1242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 BEACH 19TH ST
Provider Second Line Business Practice Location Address:
LOBBY
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-789-5301
Provider Business Practice Location Address Fax Number:
718-362-1242
Provider Enumeration Date:
07/26/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT PHARMACY SERVICES
Authorized Official Telephone Number:
806-242-7782

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05606331 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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