1386888279 NPI number — HABIT OPCO, LLC

Table of content: (NPI 1386888279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386888279 NPI number — HABIT OPCO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HABIT OPCO, 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:
Provider Other Organization Name Type Code:
6
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:
1386888279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6183 PASEO DEL NORTE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92011-1151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-259-2288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 HIGHWAY 35
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
CLIFFWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07721-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-727-2555
Provider Business Practice Location Address Fax Number:
737-727-0255
Provider Enumeration Date:
04/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FARLEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
PHILLIP
Authorized Official Title or Position:
VP & SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  2000337 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0191256 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com