1265873533 NPI number — PERSONAL GROWTH CONSULTANTS LLC

Table of content: (NPI 1265873533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265873533 NPI number — PERSONAL GROWTH CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONAL GROWTH CONSULTANTS 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:
1265873533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 WILTON CRST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06897-4053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-912-6943
Provider Business Mailing Address Fax Number:
203-454-0860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 POST RD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06880-5236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-912-6943
Provider Business Practice Location Address Fax Number:
203-454-0860
Provider Enumeration Date:
07/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BERTOLDI
Authorized Official First Name:
JANET
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
203-912-6943

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  002500 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com