1710989843 NPI number — S B HEALTH CARE ACQUISITION INC

Table of content: (NPI 1710989843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710989843 NPI number — S B HEALTH CARE ACQUISITION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S B HEALTH CARE ACQUISITION 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:
SANTA BARBARA HEALTHCARE
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:
1710989843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 S. CALLE CESAR CHAVEZ
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-892-4501
Provider Business Mailing Address Fax Number:
805-892-4511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 S. CALLE CESAR CHAVEZ
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-892-4501
Provider Business Practice Location Address Fax Number:
805-892-4511
Provider Enumeration Date:
06/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLUNT
Authorized Official First Name:
BROOKE
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
805-892-4501

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  101424 , 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: 101424 . This is a "STATE OF CA HMDRF LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DME02302G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".