1871296723 NPI number — CHERRY HEALTH SOLUTIONS LLC

Table of content: (NPI 1871296723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871296723 NPI number — CHERRY HEALTH SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERRY HEALTH 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:
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:
1871296723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 ROUTE 66 STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753-2645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
848-863-8548
Provider Business Mailing Address Fax Number:
732-941-7558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 ROUTE 66 STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-2645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
848-863-8548
Provider Business Practice Location Address Fax Number:
732-941-7558
Provider Enumeration Date:
03/22/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHERRY
Authorized Official First Name:
CHRISTALA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
848-863-8548

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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