1265777007 NPI number — HEALTHMERICA, INC.

Table of content: MS. RACHEL ANNE WILSON MSW, LSW, ACSW, QCSW (NPI 1962543918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265777007 NPI number — HEALTHMERICA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHMERICA, INC.
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:
1265777007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 W. CHAPMAN AVE.
Provider Second Line Business Mailing Address:
SUITE 177
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-539-0878
Provider Business Mailing Address Fax Number:
714-385-8155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 W. CHAPMAN AVE.
Provider Second Line Business Practice Location Address:
SUITE 177
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-539-0878
Provider Business Practice Location Address Fax Number:
714-385-8155
Provider Enumeration Date:
12/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LOW
Authorized Official First Name:
JOHNSON
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
714-539-0878

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  11613 , 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)





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