1265023196 NPI number — ABSOLUTE CARE GROUP LLC

Table of content: (NPI 1265023196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265023196 NPI number — ABSOLUTE CARE GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE CARE GROUP 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:
ACG
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:
1265023196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E BALTIMORE AVE REAR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON HEIGHTS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19018-1602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-779-1970
Provider Business Mailing Address Fax Number:
215-494-3562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 E BALTIMORE AVE REAR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON HEIGHTS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19018-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-779-1970
Provider Business Practice Location Address Fax Number:
215-494-3562
Provider Enumeration Date:
02/02/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANYUMBA
Authorized Official First Name:
OSARU
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
215-779-1970

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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