1861235905 NPI number — MRS. ALEXIS DANIELLE BAILEY CASE MANAGER

Table of content: ROBYN MASUEN (NPI 1508331091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861235905 NPI number — MRS. ALEXIS DANIELLE BAILEY CASE MANAGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
ALEXIS
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CASE MANAGER
Provider Gender Code:
F

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:
1861235905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5827 GLENN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45662-5443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-821-1544
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRONTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45638-1730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-534-1200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: CDCA.189588 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CDCA.189588 . This is a "CDCA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".