1962548875 NPI number — CENTRE FOR NEURO SKILLS - L.A.

Table of content: (NPI 1962548875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962548875 NPI number — CENTRE FOR NEURO SKILLS - L.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRE FOR NEURO SKILLS - L.A.
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:
CENTRE FOR NEURO SKILLS
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:
1962548875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5215 ASHE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93313-2069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-872-3408
Provider Business Mailing Address Fax Number:
661-872-5150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16542 VENTURA BLVD STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-783-3800
Provider Business Practice Location Address Fax Number:
818-873-8412
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
661-872-3408

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  9601311 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320700000X , with the licence number: 960001311 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9601311 . This is a "DEPT OF HEALTH SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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