1750596649 NPI number — ASSOCIATES IN THERAPY FOR INFANTS AND CHILDREN LLC

Table of content: (NPI 1750596649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750596649 NPI number — ASSOCIATES IN THERAPY FOR INFANTS AND CHILDREN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN THERAPY FOR INFANTS AND CHILDREN LLC
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:
1750596649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20909
Provider Second Line Business Mailing Address:
CHEYENNE
Provider Business Mailing Address City Name:
WY
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82003-7019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-420-2839
Provider Business Mailing Address Fax Number:
970-226-8520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3718 PIONEER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82001-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-420-2839
Provider Business Practice Location Address Fax Number:
970-226-8520
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRAHN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
970-420-2839

Provider Taxonomy Codes

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

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

  • Identifier: 115591100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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