1184957771 NPI number — SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.

Table of content: (NPI 1184957771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184957771 NPI number — SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH COUNTY COMMUNITY HEALTH CENTER, 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:
1184957771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1885 BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94303-1312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-330-7410
Provider Business Mailing Address Fax Number:
650-321-1156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1807 BAY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94303-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-330-7407
Provider Business Practice Location Address Fax Number:
650-321-1560
Provider Enumeration Date:
09/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BUADA
Authorized Official First Name:
LUISA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
650-330-7410

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  APPLIED FOR , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X , with the licence number: APPLIED FOR , 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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