1306893904 NPI number — 14766 WASHINGTON AVENUE OPERATIONS LLC

Table of content: (NPI 1306893904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306893904 NPI number — 14766 WASHINGTON AVENUE OPERATIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
14766 WASHINGTON AVENUE OPERATIONS 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:
WASHINGTON CENTER
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:
1306893904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
COMPLIANCE DEPARTMENT
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-468-4742
Provider Business Mailing Address Fax Number:
505-468-8742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14766 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LEANDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94578-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-352-2211
Provider Business Practice Location Address Fax Number:
510-352-2181
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAGER
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT DIRECTOR
Authorized Official Telephone Number:
505-821-3355

Provider Taxonomy Codes

  • Taxonomy code: 311500000X , with the licence number:  020000260 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 020000260 , 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: 850370802 . This is a "HEARTLAND HOSPICE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 850370802 . This is a "AAARP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 850370802 . This is a "UNITED AMERICAN INS CO." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZR06121I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 850370802 . This is a "VNA HOSPICE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 850370802 . This is a "HEALTH NET FLEX BENEFITS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 850370802 . This is a "KASIER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 850370802 . This is a "UTA/HUMANA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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