1417130865 NPI number — ASSOCIATED HEALTHCARE AGENCY

Table of content: (NPI 1417130865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417130865 NPI number — ASSOCIATED HEALTHCARE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED HEALTHCARE AGENCY
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:
1417130865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27508 WALNUT SPRINGS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANYON COUNTRY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91351-2822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-299-2291
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4146 E OLYMPIC BLVD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90023-3347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-262-9948
Provider Business Practice Location Address Fax Number:
323-262-3708
Provider Enumeration Date:
12/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WASHINGTON
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
RESPIRATORY CARE PRACTITIONER
Authorized Official Telephone Number:
818-232-2875

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  13861 , 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)