1346522919 NPI number — HEALTH CARE DEPOT, INC.

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 1346522919 NPI number — HEALTH CARE DEPOT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH CARE DEPOT, 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:
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:
1346522919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14440 CHERRY LANE CT
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707-4946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-992-1363
Provider Business Mailing Address Fax Number:
888-982-1363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7603 FOREST AVE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23229-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-992-1363
Provider Business Practice Location Address Fax Number:
888-982-1363
Provider Enumeration Date:
09/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
888-992-1363

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1346522919 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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