1265079164 NPI number — ALLSTAR MEDICAL RESPITE AND RECUPERATIVE CARE

Table of content: (NPI 1265079164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265079164 NPI number — ALLSTAR MEDICAL RESPITE AND RECUPERATIVE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLSTAR MEDICAL RESPITE AND RECUPERATIVE CARE
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:
1265079164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10722 ARROW RTE STE 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-4810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-945-9899
Provider Business Mailing Address Fax Number:
909-945-9799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 BRANDON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMET
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92545-3623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-945-9899
Provider Business Practice Location Address Fax Number:
909-945-9799
Provider Enumeration Date:
12/10/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHUA
Authorized Official First Name:
MARIA CATHERINE
Authorized Official Middle Name:
KOH
Authorized Official Title or Position:
CFO/ADMINISTRATOR
Authorized Official Telephone Number:
909-945-9899

Provider Taxonomy Codes

  • Taxonomy code: 177F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 075281 . This is a "RANCHO CUCAMONGA BUSINESS LICENSE TAX CERTIFICATE" identifier . This identifiers is of the category "OTHER".