1194269415 NPI number — HUMANITAS FAMILY CENTER LLC

Table of content: (NPI 1194269415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194269415 NPI number — HUMANITAS FAMILY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMANITAS FAMILY CENTER LLC
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:
1194269415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 N MONTGOMERY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OJAI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93023-2746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-909-8741
Provider Business Mailing Address Fax Number:
805-640-7844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W GROVE PKWY
Provider Second Line Business Practice Location Address:
#164
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-909-8741
Provider Business Practice Location Address Fax Number:
805-640-7844
Provider Enumeration Date:
12/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ MURILLO
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
888-909-8741

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-10-6815 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-10-6815 . This is a "BCBA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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