1871973321 NPI number — TOGETHER WE WILL GROW

Table of content: (NPI 1871973321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871973321 NPI number — TOGETHER WE WILL GROW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOGETHER WE WILL GROW
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:
1871973321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8804
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29202-8804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-222-2810
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9005 TWO NOTCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29223-5850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-222-2810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENEZ
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
704-222-2810

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1128 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com