1619929734 NPI number — ASSISTED HOME RECOVERY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619929734 NPI number — ASSISTED HOME RECOVERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSISTED HOME RECOVERY, INC.
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:
ASSISTED HOME CARE
Provider Other Organization Name Type Code:
3
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:
1619929734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 MOODY COURT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91360-6067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-371-9988
Provider Business Mailing Address Fax Number:
805-371-9987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4450 WESTINGHOUSE ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-5787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-677-2100
Provider Business Practice Location Address Fax Number:
805-677-2555
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KERSWILL
Authorized Official First Name:
GERD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
805-371-9988

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  050000513 , 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: HHA08039F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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