Provider Demographics
NPI:1922242197
Name:DANCEFIT.LLC.
Entity Type:Organization
Organization Name:DANCEFIT.LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/INSTRUCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITRA
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:JARREAU
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:251-281-2110
Mailing Address - Street 1:PO BOX 6223
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36660-0223
Mailing Address - Country:US
Mailing Address - Phone:251-281-2110
Mailing Address - Fax:251-330-1727
Practice Address - Street 1:1717 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1307
Practice Address - Country:US
Practice Address - Phone:251-281-2110
Practice Address - Fax:251-330-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL172V00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2209Medicaid
02022009OtherBLUE CROSS BLUE SHEILD
AL2209Medicaid