1306921929 NPI number — THC - ORANGE COUNTY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306921929 NPI number — THC - ORANGE COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THC - ORANGE COUNTY, 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:
KINDRED HOSPITAL - SAN FRANCISCO BAY AREA
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:
1306921929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 BENEDICT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LEANDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94577-6840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-357-8300
Provider Business Mailing Address Fax Number:
510-357-1284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 BENEDICT DR
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:
94577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-357-8300
Provider Business Practice Location Address Fax Number:
510-357-1284
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGUE
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official Telephone Number:
629-253-5121

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  140000066 , 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: HSP30705H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 052034 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HCS30705H . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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