1720282007 NPI number — FIRST STEP, INC

Table of content: (NPI 1720282007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720282007 NPI number — FIRST STEP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STEP, 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:
1720282007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10400 RIDGLAND RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
COCKEYSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21030-2715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-628-6120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3525 RESOURCE DR
Provider Second Line Business Practice Location Address:
ROOM C44
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133-4733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
999-999-9999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BITTINGER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OPERATIONS MANAGER
Authorized Official Telephone Number:
410-628-6120

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  904257 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116651400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: BA37 . This is a "BCBS MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: R583 . This is a "BCBS GHMSI (DC)" identifier . This identifiers is of the category "OTHER".




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