1609193796 NPI number — EMCL ALLIANCE, 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 1609193796 NPI number — EMCL ALLIANCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMCL ALLIANCE, 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:
ALLIANCE EL MONTE CARE 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:
1609193796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5043 PECK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL MONTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91732-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-579-1602
Provider Business Mailing Address Fax Number:
626-579-6064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5043 PECK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91732-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-579-1602
Provider Business Practice Location Address Fax Number:
626-579-6064
Provider Enumeration Date:
04/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
QUINONES
Authorized Official First Name:
ELIACIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO - MANAGING MEMBER
Authorized Official Telephone Number:
626-444-2535

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)





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