1639291651 NPI number — REMAH HEALTH SERVICES

Table of content: (NPI 1639291651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639291651 NPI number — REMAH HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REMAH HEALTH SERVICES
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:
1639291651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15544 RYON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLFLOWER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90706-3625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-867-5150
Provider Business Mailing Address Fax Number:
310-670-0990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8929 S SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-670-0911
Provider Business Practice Location Address Fax Number:
310-670-0990
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ADOH.
Authorized Official First Name:
DORIS.
Authorized Official Middle Name:
NWASOR.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR,
Authorized Official Telephone Number:
310-254-8446

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  R1AO509271126 , 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: 197227000 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 02206508 . This is a "UNIQUE PROVIDER IDENTIFICATION NUMBER (PIN)" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 02206508 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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