1275927550 NPI number — CARE GIVER SUPPORT PRODUCTS, LLC

Table of content: (NPI 1275927550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275927550 NPI number — CARE GIVER SUPPORT PRODUCTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE GIVER SUPPORT PRODUCTS, 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:
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:
1275927550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 WOODLAND PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LEANDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94577-3733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-569-2627
Provider Business Mailing Address Fax Number:
510-315-3057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
723 S CASINO CENTER BLVD
Provider Second Line Business Practice Location Address:
FLOOR 2
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89101-6716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-569-2627
Provider Business Practice Location Address Fax Number:
510-315-3057
Provider Enumeration Date:
03/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SEIDMEYER
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
LAUER
Authorized Official Title or Position:
MANAGER / PRESIDENT
Authorized Official Telephone Number:
510-569-2627

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  201022210234 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: NV20051673028 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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