1952303695 NPI number — WESTSIDE FAMILY HEALTHCARE, INC.

Table of content: (NPI 1952303695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952303695 NPI number — WESTSIDE FAMILY HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTSIDE FAMILY HEALTHCARE, 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:
NORTHEAST COMMUNITY HEALTH
Provider Other Organization Name Type Code:
5
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:
1952303695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19720-0151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-655-5822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 E 16TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19802-5145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-225-1800
Provider Business Practice Location Address Fax Number:
302-225-4526
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
LOLITA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
302-656-8292

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000356566 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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