1821409178 NPI number — SENIOR CARE CLINIC HOUSE CALLS

Table of content: (NPI 1821409178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821409178 NPI number — SENIOR CARE CLINIC HOUSE CALLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR CARE CLINIC HOUSE CALLS
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:
1821409178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 LINCOLN BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95648-6315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-543-1593
Provider Business Mailing Address Fax Number:
877-466-7829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 LINCOLN BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95648-6315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-543-1593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ORDONA
Authorized Official First Name:
RON
Authorized Official Middle Name:
BILLANO
Authorized Official Title or Position:
CLINICIAN TEAM LEAD
Authorized Official Telephone Number:
916-543-1593

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  FNP543348 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP2300X , with the licence number: FNP543348 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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