1710208863 NPI number — RECREATING POSITIVE LIVING LLC

Table of content: (NPI 1710208863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710208863 NPI number — RECREATING POSITIVE LIVING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECREATING POSITIVE LIVING 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:
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:
1710208863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
344 ROBIN HELTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOILING SPRINGS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29316-5380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-415-8640
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2375 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A-150 OFFICE 102
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29307-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-415-8640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TANNER
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
864-415-8640

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  4864 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 6631 , registered in the state of NC ; 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