1972559961 NPI number — ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.

Table of content: (NPI 1972559961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972559961 NPI number — ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCENTCARE HOME HEALTH OF CALIFORNIA, 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:
ACHH OF CA - SAN RAMON W PETALUMA
Provider Other Organization Name Type Code:
5
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:
1972559961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17855 DALLAS PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75287-6852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-267-1100
Provider Business Mailing Address Fax Number:
972-267-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3170 CROW CANYON PL STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583-1157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-734-1604
Provider Business Practice Location Address Fax Number:
925-659-0009
Provider Enumeration Date:
05/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KANE
Authorized Official First Name:
M'LISS
Authorized Official Middle Name:
JONES
Authorized Official Title or Position:
VP LEGAL
Authorized Official Telephone Number:
949-623-1582

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  020000285 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ61327Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: HHA70130G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".