1154622942 NPI number — SCATES HEALTH, INC.

Table of content: (NPI 1154622942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154622942 NPI number — SCATES HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCATES HEALTH, 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:
ACTIVE REHAB PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1154622942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1933 BANYON CMN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVERMORE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94550-4787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-518-4964
Provider Business Mailing Address Fax Number:
925-245-0334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 LINCOLN RD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94591-8206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-648-3144
Provider Business Practice Location Address Fax Number:
707-644-0630
Provider Enumeration Date:
11/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCATES
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
925-518-4964

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT27031 , 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)





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