1740823509 NPI number — POINT QUEST BEHAVIORAL HEALTH CA, 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 1740823509 NPI number — POINT QUEST BEHAVIORAL HEALTH CA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POINT QUEST BEHAVIORAL HEALTH CA, 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:
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:
1740823509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9355 E STOCKTON BLVD STE 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95624-9476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-882-8722
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9355 E STOCKTON BLVD STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95624-9476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-882-8722
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ROMIG
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, BEHAVIORAL HEALTH
Authorized Official Telephone Number:
562-882-8722

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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