1336445212 NPI number — PTL PEDIATRIC DAYCARE CENTERS INC

Table of content: (NPI 1336445212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336445212 NPI number — PTL PEDIATRIC DAYCARE CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PTL PEDIATRIC DAYCARE CENTERS 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:
1336445212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3726
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95927-3726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-891-0657
Provider Business Mailing Address Fax Number:
530-891-8853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 BEDFORD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-7352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-343-8344
Provider Business Practice Location Address Fax Number:
530-343-6683
Provider Enumeration Date:
02/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
530-891-0657

Provider Taxonomy Codes

  • Taxonomy code: 385HR2065X , with the licence number:  550000327 , 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: 550000327 . This is a "CA MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com