1083888283 NPI number — EBERHART HOME HEALTH INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083888283 NPI number — EBERHART HOME HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EBERHART HOME HEALTH 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:
1083888283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3751 N BUTLER AVE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87401-6435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-716-4238
Provider Business Mailing Address Fax Number:
505-326-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3751 N BUTLER AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-6435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-716-4238
Provider Business Practice Location Address Fax Number:
505-326-5042
Provider Enumeration Date:
04/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EBERHART
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
949-367-1868

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50553569 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com