1689979874 NPI number — BIRKMIRE BEHAVIORAL HEALTHCARE, INC

Table of content: KENNETH GEORGE LEPLEY JR. (NPI 1578897385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689979874 NPI number — BIRKMIRE BEHAVIORAL HEALTHCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIRKMIRE BEHAVIORAL HEALTHCARE, 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:
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:
1689979874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 S CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 4000
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-977-7943
Provider Business Mailing Address Fax Number:
407-977-7944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 4000
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-977-7943
Provider Business Practice Location Address Fax Number:
407-977-7944
Provider Enumeration Date:
01/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LAGOMARSINO
Authorized Official First Name:
JESSY
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE / BILLING SUPERVISOR
Authorized Official Telephone Number:
407-977-7943

Provider Taxonomy Codes

  • Taxonomy code: 103TP0016X , with the licence number:  ME75680 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com