1275298408 NPI number — PATTERSON CARING HEARTS LLC

Table of content: (NPI 1275298408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275298408 NPI number — PATTERSON CARING HEARTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATTERSON CARING HEARTS 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:
1275298408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 HAMPTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTCHTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10941-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
277 FAIRFIELD RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07004-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-532-7933
Provider Business Practice Location Address Fax Number:
972-532-7933
Provider Enumeration Date:
11/02/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAVIER
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-800-4565

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0 . This is a "ALL HEALTHCARE INSURANCES" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".