1962832071 NPI number — ARDON HEALTH, LLC

Table of content: (NPI 1962832071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962832071 NPI number — ARDON HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARDON HEALTH, LLC
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:
ARDON HEALTH, LLC
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:
1962832071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11835 NE GLENN WIDING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97220-9057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-425-4101
Provider Business Mailing Address Fax Number:
855-425-4104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11835 NE GLENN WIDING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97220-9057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-425-4085
Provider Business Practice Location Address Fax Number:
855-425-4096
Provider Enumeration Date:
11/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPMAN
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-444-6529

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  PMP-1004 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PCN.0002782 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 64002411A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PH28357 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NRX1701250 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 054.018529 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NRP2008 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: A9-0002058 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 46361MS , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHA-O1385 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X , with the licence number: 22-103391 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: OSP.0006445 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 4361 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: Y005898 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHNR000256 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1609651 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962832071 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19628790 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100529010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8980063-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026742100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962832071 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2034813 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7R2854 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2143280 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3006801 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 365515 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000163242 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1035155530001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962832071 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500668204 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962832071 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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