Provider Demographics
NPI:1215703434
Name:LEXX ALT GALAXY LLC
Entity type:Organization
Organization Name:LEXX ALT GALAXY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-375-8257
Mailing Address - Street 1:1579 MEREDITH DR UNIT 10
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3243
Mailing Address - Country:US
Mailing Address - Phone:513-375-8257
Mailing Address - Fax:
Practice Address - Street 1:1579 MEREDITH DR UNIT 10
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3243
Practice Address - Country:US
Practice Address - Phone:513-375-8257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEXX ALT GALAXY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty