1780748129 NPI number — ACCELLENCE HOME MEDICAL ARCADIA, INC.

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 1780748129 NPI number — ACCELLENCE HOME MEDICAL ARCADIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCELLENCE HOME MEDICAL ARCADIA, 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:
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:
1780748129
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:
PO BOX 661148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCADIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91066-1148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-445-0806
Provider Business Mailing Address Fax Number:
626-445-5448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 E DUARTE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91006-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-445-0806
Provider Business Practice Location Address Fax Number:
626-445-5448
Provider Enumeration Date:
12/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VILLANUEVA
Authorized Official First Name:
ERENEA
Authorized Official Middle Name:
DAR JUAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-445-0806

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  100600 , 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: DME01828F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".