1023215373 NPI number — SOUTH VALLEY HEALTHCARE, 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 1023215373 NPI number — SOUTH VALLEY HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH VALLEY HEALTHCARE, 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:
1023215373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27101 PUERTA REAL
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-8518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-540-1249
Provider Business Mailing Address Fax Number:
949-540-1966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12702 FORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRAPER
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84020-9755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-571-2704
Provider Business Practice Location Address Fax Number:
801-571-8921
Provider Enumeration Date:
06/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURNAM
Authorized Official First Name:
SOON
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
949-540-1249

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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