1962476432 NPI number — NORTH VALLEY DEVELOPMENTAL SERVICES INC

Table of content: DR. TALAL M. GHAZAL MD (NPI 1700080520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962476432 NPI number — NORTH VALLEY DEVELOPMENTAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH VALLEY DEVELOPMENTAL SERVICES 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:
NVDS INC - HARPOLE
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:
1962476432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 492478
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-226-0375
Provider Business Mailing Address Fax Number:
530-365-1609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HARPOLE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-226-0375
Provider Business Practice Location Address Fax Number:
530-365-1609
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO / OWNER
Authorized Official Telephone Number:
530-226-0375

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  230000218 , 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: LTC60530H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC60590H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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