1255562229 NPI number — ABILITY CENTER

Table of content: (NPI 1255562229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255562229 NPI number — ABILITY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABILITY CENTER
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:
ABILITY CENTER ORANGE COUNTY
Provider Other Organization Name Type Code:
5
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:
1255562229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4797 RUFFNER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92111-1519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-541-0552
Provider Business Mailing Address Fax Number:
858-541-1941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11600 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-890-8262
Provider Business Practice Location Address Fax Number:
714-901-1492
Provider Enumeration Date:
08/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HEATH
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
858-541-0552

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DME02121F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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