1750583670 NPI number — MORNINGSTAR CHILDREN AND FAMILY SERVICES, INC.

Table of content: (NPI 1750583670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750583670 NPI number — MORNINGSTAR CHILDREN AND FAMILY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORNINGSTAR CHILDREN AND FAMILY SERVICES, 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:
1750583670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-267-7583
Provider Business Mailing Address Fax Number:
912-267-9568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3596 DARIEN HWY
Provider Second Line Business Practice Location Address:
SUITES 4 & 5
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31525-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-267-3701
Provider Business Practice Location Address Fax Number:
912-267-0235
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KILGORE
Authorized Official First Name:
WELLS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
912-267-3700

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  CCI0000011057 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 860119541A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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