1326234022 NPI number — SENECA HEALTHCARE DISTRICT

Table of content: (NPI 1326234022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326234022 NPI number — SENECA HEALTHCARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENECA HEALTHCARE DISTRICT
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:
1326234022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-258-2151
Provider Business Mailing Address Fax Number:
530-258-3471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 BRENTWOOD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-258-2151
Provider Business Practice Location Address Fax Number:
530-258-3471
Provider Enumeration Date:
09/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
530-258-2067

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  230000032 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NR1301X , with the licence number: 230000032 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: LTC55022F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".