1881656734 NPI number — A STEP AHEAD THERAPY CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881656734 NPI number — A STEP AHEAD THERAPY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A STEP AHEAD THERAPY CENTER, 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:
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:
1881656734
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:
3606 KIMBALL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50702-5731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-234-3736
Provider Business Mailing Address Fax Number:
319-234-0401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3606 KIMBALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50702-5731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-234-3736
Provider Business Practice Location Address Fax Number:
319-234-0401
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARTLING
Authorized Official First Name:
ALECA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
319-234-3736

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  03011 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 02547 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35404 . This is a "WELLMARK INDIVIDUAL NUMBE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0415620 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35403 . This is a "WELLMARK INDIVIDUAL NUMBE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0415612 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0415638 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35402 . This is a "WELLMARK OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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