1609194356 NPI number — WK CENTER FOR PSYCHIATRIC SUPPORT

Table of content: (NPI 1609194356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609194356 NPI number — WK CENTER FOR PSYCHIATRIC SUPPORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WK CENTER FOR PSYCHIATRIC SUPPORT
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:
1609194356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 LINE AVE 3RD FLOOR TOWER 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71101-3981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-716-4610
Provider Business Mailing Address Fax Number:
318-716-4690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 LINE AVE 3RD FLOOR TOWER 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101-3981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-716-4610
Provider Business Practice Location Address Fax Number:
318-716-4690
Provider Enumeration Date:
05/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GAVIN
Authorized Official First Name:
GREG
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
NETWORK ADMINISTRATOR
Authorized Official Telephone Number:
318-212-4232

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; 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