1578668976 NPI number — VOLUNTEERS OF AMERICA SOUTHWEST CALIFORNIA

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 1578668976 NPI number — VOLUNTEERS OF AMERICA SOUTHWEST CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VOLUNTEERS OF AMERICA SOUTHWEST CALIFORNIA
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:
1578668976
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:
3530 CAMINO DEL RIO NORTH
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-282-8211
Provider Business Mailing Address Fax Number:
619-282-1300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E. SECOND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-355-2858
Provider Business Practice Location Address Fax Number:
760-355-4550
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCFADDEN
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
619-282-8211

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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)

  • Identifier: ZZT18592L , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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