1952533200 NPI number — RCR STAR NEVADA, 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 1952533200 NPI number — RCR STAR NEVADA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RCR STAR NEVADA, 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:
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:
1952533200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2608 VICTOR AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96002-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-722-1530
Provider Business Mailing Address Fax Number:
530-226-8293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1950 COLLEGE PKWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89706-7988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-883-4455
Provider Business Practice Location Address Fax Number:
775-841-1133
Provider Enumeration Date:
08/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SEAWRIGHT
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-722-1530

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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