1861795890 NPI number — APPLETON SENIOR CARE, INC

Table of content: (NPI 1861795890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861795890 NPI number — APPLETON SENIOR CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLETON SENIOR CARE, INC
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:
1861795890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35403-2329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-764-0387
Provider Business Mailing Address Fax Number:
205-764-0569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3630 NORTHBROOK DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35473-5822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-764-0387
Provider Business Practice Location Address Fax Number:
205-764-0569
Provider Enumeration Date:
12/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BUFFALOE
Authorized Official First Name:
STEPHAINE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
FRANCHISE OWNER
Authorized Official Telephone Number:
205-764-0387

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R007434438 . This is a "VETERANS ADMIN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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