1881601375 NPI number — LOS NINOS THERAPY CENTER

Table of content: (NPI 1881601375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881601375 NPI number — LOS NINOS THERAPY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS NINOS THERAPY CENTER
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:
1881601375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1436
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS LUNAS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87031-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-865-7955
Provider Business Mailing Address Fax Number:
505-866-7191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 LUNA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS LUNAS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-865-7955
Provider Business Practice Location Address Fax Number:
505-866-7191
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
TONI ANN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PT/ADMINISTRATOR
Authorized Official Telephone Number:
505-865-7955

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D0641 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 695951 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NN00N637 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: QMYPR0072204 . This is a "MOLINA HEALTHCARE OF NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: K2312 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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