1184973018 NPI number — NCA HOLDINGS OF ARIZONA, LLC

Table of content: (NPI 1184973018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184973018 NPI number — NCA HOLDINGS OF ARIZONA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NCA HOLDINGS OF ARIZONA, 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:
NEW PROMISE NEUROPATHY CARE CENTERS
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:
1184973018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7558 W THUNDERBIRD RD
Provider Second Line Business Mailing Address:
SUITE 1-496
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85381-6080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13090 N 94TH DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-977-2707
Provider Business Practice Location Address Fax Number:
623-977-2331
Provider Enumeration Date:
09/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ALAVI
Authorized Official First Name:
ALI
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-602-2626

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 746289 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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