1962791715 NPI number — SEVA HEALTHCARE, LLC

Table of content: (NPI 1962791715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962791715 NPI number — SEVA HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEVA HEALTHCARE, 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:
BRIGHTSTAR OF CHARLOTTE, BRIGHTSTAR HEALTHCARE CHARLOTTE
Provider Other Organization Name Type Code:
3
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:
1962791715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 ABBOTT ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28203-4497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-919-0955
Provider Business Mailing Address Fax Number:
704-919-0998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 ABBOTT ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203-4497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-919-0955
Provider Business Practice Location Address Fax Number:
704-919-0998
Provider Enumeration Date:
04/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HIJAZIN
Authorized Official First Name:
KULVINDER
Authorized Official Middle Name:
KAUR
Authorized Official Title or Position:
OWNER, PRESIDENT, AGENCY DIRECTOR
Authorized Official Telephone Number:
704-919-0955

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  HC3879 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: HC3879 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: HC3879 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3418749 . This is a "MEDICAID COMMUNITY ALTERNATIVE PROGRAM" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com