1396168522 NPI number — MINDS IN MOTION CHILDREN'S CENTER, LLC

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 1396168522 NPI number — MINDS IN MOTION CHILDREN'S CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINDS IN MOTION CHILDREN'S CENTER, 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:
1396168522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8041 CESSNA AVE
Provider Second Line Business Mailing Address:
STE 232
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20879-4169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-977-9393
Provider Business Mailing Address Fax Number:
301-977-9394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8041 CESSNA AVE
Provider Second Line Business Practice Location Address:
STE 232
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20879-4169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-977-9393
Provider Business Practice Location Address Fax Number:
301-977-9394
Provider Enumeration Date:
01/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GASAWAY
Authorized Official First Name:
LATISHA
Authorized Official Middle Name:
JANNELL
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
301-977-9393

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 158434 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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