1629145602 NPI number — WHITTIER HEALTH SERVICES INC

Table of content: (NPI 1629145602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629145602 NPI number — WHITTIER HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITTIER HEALTH SERVICES INC
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:
WHITTIER PLACE
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:
1629145602
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:
30 WHITTIER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GHENT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12075-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-828-0900
Provider Business Mailing Address Fax Number:
518-828-1201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 WHITTIER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GHENT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12075-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-828-0900
Provider Business Practice Location Address Fax Number:
518-828-1201
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARCIDI
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
978-556-5900

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  200E005 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02085803 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".