1043252554 NPI number — INTERIM HEALTHCARE OF RIVERSIDE, INC.

Table of content: (NPI 1043252554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043252554 NPI number — INTERIM HEALTHCARE OF RIVERSIDE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE OF RIVERSIDE, 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:
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:
1043252554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 SAWGRASS CORPORATE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-858-2871
Provider Business Mailing Address Fax Number:
954-858-2710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 INDIANA AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92506-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-684-6111
Provider Business Practice Location Address Fax Number:
951-781-9947
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLUPECKI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
954-858-2753

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  240000032 , 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: HHA70293G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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