1760859656 NPI number — MICHELLE KERSKA, BCBA, PC

Table of content: (NPI 1760859656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760859656 NPI number — MICHELLE KERSKA, BCBA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELLE KERSKA, BCBA, PC
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:
1760859656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7220 W JEFFERSON AVE
Provider Second Line Business Mailing Address:
401
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80235-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-531-0804
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7220 W JEFFERSON AVE
Provider Second Line Business Practice Location Address:
401
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80235-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-531-0804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KERSKA
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
858-531-0804

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1073382 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 67775233 . This is a "MEDICAID HCBS WAIVER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com