1245336056 NPI number — INTERIM HEALTHCARE OF NORTHERN CALIFORNIA

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 1245336056 NPI number — INTERIM HEALTHCARE OF NORTHERN CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE OF NORTHERN CALIFORNIA
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:
1245336056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 EXECUTIVE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96002-0630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-221-1212
Provider Business Mailing Address Fax Number:
530-221-7836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1647 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-221-1212
Provider Business Practice Location Address Fax Number:
530-221-7836
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEAWRIGHT
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
ADINE
Authorized Official Title or Position:
DIRECTOR OF HEALTHCARE
Authorized Official Telephone Number:
530-221-1212

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  230000258 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HHA57630F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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