1952545527 NPI number — JES HOME & HEALTH CARE SERVICES PROVIDER LLC

Table of content: NOAH THOMAS SMITH DPT (NPI 1437650975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952545527 NPI number — JES HOME & HEALTH CARE SERVICES PROVIDER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JES HOME & HEALTH CARE SERVICES PROVIDER 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:
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:
1952545527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92702-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-834-9742
Provider Business Mailing Address Fax Number:
714-834-9742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 N FLOWER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92706-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-834-9742
Provider Business Practice Location Address Fax Number:
714-834-9742
Provider Enumeration Date:
04/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TUZARA
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
TEVES
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
714-488-8909

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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