1740713833 NPI number — ATHENA THERAPY HOLDING CO

Table of content: (NPI 1740713833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740713833 NPI number — ATHENA THERAPY HOLDING CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHENA THERAPY HOLDING CO
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:
ATHENA THERAPY
Provider Other Organization Name Type Code:
3
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:
1740713833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4293 COLUMBIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-7707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-410-3982
Provider Business Mailing Address Fax Number:
330-451-5711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
798 E LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIRARD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44420-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-545-6550
Provider Business Practice Location Address Fax Number:
330-545-6877
Provider Enumeration Date:
04/06/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRADFORD
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-410-3982

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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