1821125055 NPI number — THE NARROW GATE LLC

Table of content: (NPI 1821125055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821125055 NPI number — THE NARROW GATE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NARROW GATE 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:
1821125055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1008 W OHIO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47872-1536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-569-5350
Provider Business Mailing Address Fax Number:
765-569-5340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 W OHIO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47872-1536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-569-5350
Provider Business Practice Location Address Fax Number:
765-569-5340
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANNER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PROVIDER/ADMIN/MEMBER
Authorized Official Telephone Number:
765-569-5350

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  20041104A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TA0400X , with the licence number: 20041104A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200904480A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 224190 . This is a "PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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