1144710559 NPI number — G&A CANTILLER INC

Table of content: (NPI 1144710559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144710559 NPI number — G&A CANTILLER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G&A CANTILLER 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:
CAMELOT CARE BUCKS HARBOR
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:
1144710559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9616 RICHLYN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95757-4034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-803-0815
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8006 BUCKS HARBOR WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95828-5435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-689-5491
Provider Business Practice Location Address Fax Number:
916-627-1307
Provider Enumeration Date:
05/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CANTILLER
Authorized Official First Name:
ARACELI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
916-803-0815

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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