1972048411 NPI number — ACTS SIGNATURE COMMUNITY SERVICES, 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 1972048411 NPI number — ACTS SIGNATURE COMMUNITY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTS SIGNATURE COMMUNITY SERVICES, 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:
PRIMARY CARE SERVICES AT INDIAN RIVER ESTATES
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:
1972048411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19034-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-661-8330
Provider Business Mailing Address Fax Number:
215-661-8336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 INDIAN CREEK BLVD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32966-1395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-562-7400
Provider Business Practice Location Address Fax Number:
772-778-7747
Provider Enumeration Date:
12/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
AHERN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, CFO
Authorized Official Telephone Number:
215-661-8330

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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