1679665970 NPI number — WESTSIDE COMMUNITY HEALTHCARE DISTRICT

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 1679665970 NPI number — WESTSIDE COMMUNITY HEALTHCARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTSIDE COMMUNITY HEALTHCARE DISTRICT
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:
6
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:
1679665970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWMAN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95360-0746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-862-2951
Provider Business Mailing Address Fax Number:
786-725-3470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 SOUTH HIGHWAY 33
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWMAN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-862-2951
Provider Business Practice Location Address Fax Number:
209-854-2174
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAZIL
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT/BOARD CHAIRMAN
Authorized Official Telephone Number:
209-862-2951

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MTE00175F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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