1912256827 NPI number — HOP SKIP AND A JUMP LLC

Table of content: (NPI 1912256827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912256827 NPI number — HOP SKIP AND A JUMP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOP SKIP AND A JUMP 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:
1912256827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 WINDSOR PATH
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40324-9617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-570-2337
Provider Business Mailing Address Fax Number:
502-570-2338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 WINDSOR PATH
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-9617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-570-2337
Provider Business Practice Location Address Fax Number:
502-570-2338
Provider Enumeration Date:
09/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BEEBE
Authorized Official First Name:
ANN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OTR/L
Authorized Official Telephone Number:
502-570-2337

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100236820 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000800679 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100302990 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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