1417255647 NPI number — KERRIA HOLDINGS, 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 1417255647 NPI number — KERRIA HOLDINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERRIA HOLDINGS, 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:
WESTVIEW HEALTHCARE CENTER
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:
1417255647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E SAN MARCOS BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92069-2986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-471-0388
Provider Business Mailing Address Fax Number:
760-471-0311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12225 SHALE RIDGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95602-8870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-885-7511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBARD
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
760-471-0388

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1417255647 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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