1942690904 NPI number — SERVANT HEART HELPERS, INC.

Table of content: (NPI 1942690904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942690904 NPI number — SERVANT HEART HELPERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVANT HEART HELPERS, 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:
6
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:
1942690904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 S FARMER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTSEGO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49078-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-692-2074
Provider Business Mailing Address Fax Number:
775-514-8859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 S FARMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTSEGO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49078-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-692-2074
Provider Business Practice Location Address Fax Number:
775-514-8859
Provider Enumeration Date:
01/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LUST
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
269-692-2074

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  45490C , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8779373 . This is a "DEPARTMENT OF HUMAN SERVICES - CHORE PROVIDER SERVICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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