1295101301 NPI number — ACCOUNTABLE CARE POST ACUTE PROVIDERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295101301 NPI number — ACCOUNTABLE CARE POST ACUTE PROVIDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCOUNTABLE CARE POST ACUTE PROVIDERS
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:
1295101301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3461 FAIRLANE FARMS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-8752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-766-1300
Provider Business Mailing Address Fax Number:
561-693-0539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3461 FAIRLANE FARMS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-8752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-766-1300
Provider Business Practice Location Address Fax Number:
561-693-0539
Provider Enumeration Date:
08/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GHIRAGOSSIAN
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
MBR
Authorized Official Telephone Number:
561-766-1300

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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