1710495809 NPI number — ABILITY, LLC - III

Table of content: (NPI 1710495809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710495809 NPI number — ABILITY, LLC - III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABILITY, LLC - III
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:
1710495809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 HOLMES PITTMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOXWORTH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39483-3166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-441-9821
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6092 PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLERTOWN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39667-9211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-441-6161
Provider Business Practice Location Address Fax Number:
601-444-5036
Provider Enumeration Date:
01/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
601-441-9821

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  S3330 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08025091 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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