1265508733 NPI number — MR. HOWARD CHANDLER PORTER II ACSW

Table of content: MR. HOWARD CHANDLER PORTER II ACSW (NPI 1265508733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265508733 NPI number — MR. HOWARD CHANDLER PORTER II ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTER
Provider First Name:
HOWARD
Provider Middle Name:
CHANDLER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
ACSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PORTER
Provider Other First Name:
HOWARD
Provider Other Middle Name:
CHANDLER
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
II
Provider Other Credential Text:
ACSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265508733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 BILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARADISE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95969-3043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-877-4893
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 CEDAR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-877-5845
Provider Business Practice Location Address Fax Number:
530-877-3976
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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