1891352035 NPI number — NJUNGEA SERVICES LLC

Table of content: (NPI 1891352035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891352035 NPI number — NJUNGEA SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NJUNGEA SERVICES 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:
1891352035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 934
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46131-0934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-560-2657
Provider Business Mailing Address Fax Number:
317-739-3883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 HANNAH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46131-7493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-560-2657
Provider Business Practice Location Address Fax Number:
317-739-3883
Provider Enumeration Date:
05/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
NJUNGE
Authorized Official First Name:
ALICE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
317-560-2657

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1124227830 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com