1922452036 NPI number — PINELLAS OPPORTUNITY COUNTIL, 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 1922452036 NPI number — PINELLAS OPPORTUNITY COUNTIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINELLAS OPPORTUNITY COUNTIL, 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:
1922452036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4039 8TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33711-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-327-3091
Provider Business Mailing Address Fax Number:
727-327-2340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4039 8TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33711-2004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-327-3091
Provider Business Practice Location Address Fax Number:
727-327-2340
Provider Enumeration Date:
04/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
727-823-4101

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)





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