1629106547 NPI number — MENTORS RESOURCE & DEVELOPMENT CORP

Table of content: (NPI 1629106547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629106547 NPI number — MENTORS RESOURCE & DEVELOPMENT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTORS RESOURCE & DEVELOPMENT CORP
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:
1629106547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR #2 BOX 1016C
Provider Second Line Business Mailing Address:
EMERY RD
Provider Business Mailing Address City Name:
DINGMANS FERRY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-344-0392
Provider Business Mailing Address Fax Number:
845-344-0392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RR H2 BOX 1016C
Provider Second Line Business Practice Location Address:
EMERY RD
Provider Business Practice Location Address City Name:
DINGMANS FERRY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-344-0392
Provider Business Practice Location Address Fax Number:
845-344-0392
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOERGER
Authorized Official First Name:
JAY
Authorized Official Middle Name:
HERMAN
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
845-344-0392

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  95311 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: PS009154L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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