1417165259 NPI number — SAVANNAH CHILDREN'S THERAPY CENTER, LLC

Table of content: DR. SAMUEL ECKEL PHARMD (NPI 1003362468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417165259 NPI number — SAVANNAH CHILDREN'S THERAPY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAVANNAH CHILDREN'S THERAPY 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:
CHILDREN'S THERAPY CENTER
Provider Other Organization Name Type Code:
3
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:
1417165259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11550 ABERCORN ST
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31419-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-927-5096
Provider Business Mailing Address Fax Number:
912-927-5097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11550 ABERCORN ST
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31419-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-927-5096
Provider Business Practice Location Address Fax Number:
912-927-5097
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRUIN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
912-927-5096

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT006834 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OT001992 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP006630 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP005804 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP006487 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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