1366498164 NPI number — ACCENTCARE HOME HEALTH OF CALIFORNIA, INC

Table of content: (NPI 1366498164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366498164 NPI number — ACCENTCARE HOME HEALTH OF CALIFORNIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCENTCARE HOME HEALTH OF CALIFORNIA, 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:
ACHH OF CA - CIRCLEVILLE
Provider Other Organization Name Type Code:
5
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:
1366498164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17855 N. DALLAS PKWY.
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75287-6857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-267-1100
Provider Business Mailing Address Fax Number:
972-267-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 S COURT ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CIRCLEVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43113-1658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-474-7826
Provider Business Practice Location Address Fax Number:
740-474-5456
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ-DOTY
Authorized Official First Name:
DENA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/SECRETARY
Authorized Official Telephone Number:
972-201-3819

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  N/A ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OH - 2062904 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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