1932543634 NPI number — FIRST IMPRESSIONS COMMUNITY DEVELOPEMENT CORP.

Table of content: (NPI 1932543634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932543634 NPI number — FIRST IMPRESSIONS COMMUNITY DEVELOPEMENT CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST IMPRESSIONS COMMUNITY DEVELOPEMENT CORP.
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:
1932543634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20101 NW 34TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33056-1768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-572-6250
Provider Business Mailing Address Fax Number:
305-248-4284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13366 SW 288TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33033-1927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-572-6250
Provider Business Practice Location Address Fax Number:
305-248-4284
Provider Enumeration Date:
04/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
SHATARIA
Authorized Official Middle Name:
BRIDGES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-572-6250

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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