NPI |
1497218101 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
INNER VIBRANCE, LLC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
360 BLOOMFIELD AVE STE 301 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
WINDSOR |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
CT |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
060952700 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
8602817687 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
8609101411 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
4/9/2019 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/15/2019 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
SCHMIDT |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
KAITLIN |
The first name of the authorized official. |
Authorized Official Title or Position |
OWNER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
8602817687 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QM0801X |
The 10-position telephone number of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|