NPI |
1548340920 |
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 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
OLDIES BUT GOODIES ADULT DAY CARE, INC |
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 |
741 W 25TH AVE |
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 Second Line Business Practice Location Address |
SAME |
The second 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 |
GARY |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
IN |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Business Practice Location Address Postal Code |
464073524 |
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 |
2198861670 |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
2198861670 |
The State code in the location of the provider
being identified. |
Provider Enumeration Date |
10/17/2006 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Last Update Date |
5/23/2008 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Authorized Official Last Name |
BIDDINGS |
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. |
Authorized Official First Name |
ANGELA |
The city name in the location address of the provider being identified. |
Authorized Official Middle Name |
YVETT |
The State code in the location of the provider
being identified. |
Authorized Official Title or Position |
EXECUTIVE DIRECTOR |
The State code in the location of the provider
being identified. |
Authorized Official Telephone Number |
2198861670 |
The country code in the location address of the provider being identified. |
Healthcare Provider Taxonomy Code 1 |
311ZA0620X |
The telephone number associated with the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The date the provider was assigned a unique identifier (assigned an NPI). |
Other Provider Identifier 1 |
200266600 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Other Provider Identifier Type Code 1 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
IN |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MRS. |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Authorized Official Credential Text |
LPN |
|