1740367747 NPI number — SWEET SPRINGS THERAPY CENTER INC

Table of content: (NPI 1740367747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740367747 NPI number — SWEET SPRINGS THERAPY CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEET SPRINGS THERAPY CENTER 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:
1740367747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45
Provider Second Line Business Mailing Address:
718 BRIDGE STREET
Provider Business Mailing Address City Name:
SWEET SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-335-4431
Provider Business Mailing Address Fax Number:
660-335-4134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 BRIDGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEET SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-335-4431
Provider Business Practice Location Address Fax Number:
660-335-4134
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUMILANG
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
ROMARATE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
660-335-4431

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35640019 . This is a "CTC BCBS OF KC GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40284 . This is a "BTC HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21182036 . This is a "CTC BCBS OF KC INDIV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35641017 . This is a "MTC BCBS OF KC GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35644011 . This is a "BTC BCBS OF KC GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21182026 . This is a "SSTC BCBS OF KC INDIV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21182056 . This is a "BTC BCBS OF KC INDIV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40282 . This is a "CTC HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21491034 . This is a "SSTC BCBS OF KC GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40285 . This is a "MTC HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9368 . This is a "SSTC HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21182046 . This is a "MTC BCBS OF KC INDIV" identifier . This identifiers is of the category "OTHER".




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