1740470442 NPI number — COUNT TO TEN, INC

Table of content: (NPI 1740470442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740470442 NPI number — COUNT TO TEN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNT TO TEN, 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:
1740470442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5404 W 25TH AVE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
GARY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46406-3141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-989-9759
Provider Business Mailing Address Fax Number:
219-989-9757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5404 W 25TH AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
GARY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46406-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-989-9759
Provider Business Practice Location Address Fax Number:
219-989-9757
Provider Enumeration Date:
07/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
FRANKLYN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
219-989-9759

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  6600003-01 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M400014630 . This is a "MEDICARE IDENTIFICATION NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: M100014629 . This is a "MEDICARE IDENTIFICATION NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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