1861848129 NPI number — INTEGRATIVE THERAPEUTIC SOLUTIONS, LLC

Table of content: (NPI 1861848129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861848129 NPI number — INTEGRATIVE THERAPEUTIC SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE THERAPEUTIC SOLUTIONS, 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:
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:
1861848129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 OLYMPIC DR STE H105
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-1491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-514-6842
Provider Business Mailing Address Fax Number:
253-514-6863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5775 SOUNDVIEW DR
Provider Second Line Business Practice Location Address:
A-103
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-651-3421
Provider Business Practice Location Address Fax Number:
253-514-6863
Provider Enumeration Date:
05/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KRAUS
Authorized Official First Name:
MARIEL
Authorized Official Middle Name:
CASTANEDA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
253-514-6842

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  603406965 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G8946103 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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