1053425470 NPI number — THE CENTER FOR CONTINENCE CARE, INC

Table of content: (NPI 1053425470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053425470 NPI number — THE CENTER FOR CONTINENCE CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CENTER FOR CONTINENCE CARE, 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:
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:
1053425470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
948 MOODY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93619-7553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-299-6592
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2763 E SHAW AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-8220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-294-8112
Provider Business Practice Location Address Fax Number:
559-294-7805
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEBB
Authorized Official First Name:
MARILYN-LU
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
559-299-6592

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  G68291 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LA2200X , with the licence number: 373569 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: GR0098160 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com