1952303737 NPI number — THE HENRY & RILLA WHITE YOUTH FOUNDATION INC

Table of content: (NPI 1952303737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952303737 NPI number — THE HENRY & RILLA WHITE YOUTH FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HENRY & RILLA WHITE YOUTH FOUNDATION 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:
HENRY & RILLA WHITE FOUNDATION INC
Provider Other Organization Name Type Code:
5
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:
1952303737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2833 REMINGTON GREEN CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-3752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-922-8375
Provider Business Mailing Address Fax Number:
850-488-2071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 NW CHRISTIAN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32055-4837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-752-7813
Provider Business Practice Location Address Fax Number:
352-752-7836
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DURRANCE
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
850-922-8375

Provider Taxonomy Codes

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

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

  • Identifier: 055048511 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048504 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048507 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048508 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048517 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048521 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048502 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048518 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048505 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048506 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048514 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048522 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048501 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048516 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 055048515 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 076660700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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