1053724716 NPI number — 10 ACRE RANCH

Table of content: (NPI 1053724716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053724716 NPI number — 10 ACRE RANCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
10 ACRE RANCH
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:
1053724716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5953 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92504-1369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-266-7044
Provider Business Mailing Address Fax Number:
951-784-7084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8605 JANET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92503-9212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-228-4679
Provider Business Practice Location Address Fax Number:
951-602-6655
Provider Enumeration Date:
06/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JADALLAH
Authorized Official First Name:
ISMAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
714-833-4826

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , 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)





Copyright © 2007-2025 www.npivalidator.com