1376769505 NPI number — SUMMERFIELD SENIOR CARE

Table of content: (NPI 1376769505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376769505 NPI number — SUMMERFIELD SENIOR CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMERFIELD SENIOR CARE
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:
1376769505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4610 NE 77TH AVE
Provider Second Line Business Mailing Address:
SUITE #132
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98662-6789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-449-4524
Provider Business Mailing Address Fax Number:
360-449-4525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1224 PLUMAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95991-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-755-3850
Provider Business Practice Location Address Fax Number:
530-755-3875
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEAULIEU
Authorized Official First Name:
MINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
530-755-3850

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , 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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