1528286804 NPI number — DACAREINC

Table of content: (NPI 1528286804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528286804 NPI number — DACAREINC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DACAREINC
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:
1528286804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
643 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAWLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92227-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-344-4654
Provider Business Mailing Address Fax Number:
760-344-4608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 MERCED AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-5332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-388-9175
Provider Business Practice Location Address Fax Number:
209-388-9176
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MACHADO
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER ADMINISTRATOR
Authorized Official Telephone Number:
760-344-4654

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ADU70145F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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