1841350899 NPI number — SALAM PSYCHIATRIC SERVICES, P.L.C

Table of content: (NPI 1841350899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841350899 NPI number — SALAM PSYCHIATRIC SERVICES, P.L.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALAM PSYCHIATRIC SERVICES, P.L.C
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:
1841350899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 TECHNOLOGY DRI
Provider Second Line Business Mailing Address:
# 9
Provider Business Mailing Address City Name:
BRATTLEBORO
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-246-0781
Provider Business Mailing Address Fax Number:
802-246-0742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 TECHNOLOGY DRIVE
Provider Second Line Business Practice Location Address:
# 9
Provider Business Practice Location Address City Name:
BRATTLEBORO
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-246-0781
Provider Business Practice Location Address Fax Number:
802-246-0742
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SALAM
Authorized Official First Name:
SABA
Authorized Official Middle Name:
MAHEEN
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
802-246-0781

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  42-0010331 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SALA00069122 . This is a "BCBSVT GROUP NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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