1295832665 NPI number — AHWAHNEE CARE HOMES, INC.

Table of content: (NPI 1295832665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295832665 NPI number — AHWAHNEE CARE HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHWAHNEE CARE HOMES, INC.
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:
1295832665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AHWAHNEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93601-0346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-658-2444
Provider Business Mailing Address Fax Number:
559-641-7898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444665 ROAD 619
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AHWAHNEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-658-2444
Provider Business Practice Location Address Fax Number:
559-641-7898
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENS
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
CLARKE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
559-658-2444

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  05G815 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 55G074 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 05G904 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LTC80133F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC80200F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC80099F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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