1871569764 NPI number — HIGH DESERT THERAPY ASSOCIATES INC

Table of content: JENNA ALEXANDRIA BRADLEY (NPI 1235015587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871569764 NPI number — HIGH DESERT THERAPY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH DESERT THERAPY ASSOCIATES 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:
1871569764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRIVER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-593-8535
Provider Business Mailing Address Fax Number:
541-593-0316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56881 ENTERPRISE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNRIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-593-8535
Provider Business Practice Location Address Fax Number:
541-593-0316
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PHILIP
Authorized Official Title or Position:
TREASURER BUSINESS MANAGER
Authorized Official Telephone Number:
541-593-8535

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com