1831574078 NPI number — TWENTY PACK MANAGEMENT CORPORATION

Table of content: (NPI 1831574078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831574078 NPI number — TWENTY PACK MANAGEMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWENTY PACK MANAGEMENT CORPORATION
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:
1831574078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 WILSON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22205-1548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-536-1060
Provider Business Mailing Address Fax Number:
703-444-8294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 WILSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22205-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-536-1060
Provider Business Practice Location Address Fax Number:
703-444-8294
Provider Enumeration Date:
07/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DENNISON
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
703-536-1060

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  BLC-1000030930-05 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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