1124300207 NPI number — LIVINGSTON COMMUNITY HEALTH

Table of content: (NPI 1124300207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124300207 NPI number — LIVINGSTON COMMUNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVINGSTON COMMUNITY HEALTH
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:
1124300207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95334-1257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-394-7913
Provider Business Mailing Address Fax Number:
209-394-9093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7970 LANDER AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HILMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95324-8310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-262-1819
Provider Business Practice Location Address Fax Number:
209-262-1817
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCGOWAN
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
209-394-1365

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; 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