1356396410 NPI number — STAFF ASSISTANCE, INC.

Table of content: (NPI 1356396410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356396410 NPI number — STAFF ASSISTANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAFF ASSISTANCE, 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:
1356396410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 MOODY COURT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91360-6067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-371-9988
Provider Business Mailing Address Fax Number:
805-371-9987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10550 SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-3562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-894-7879
Provider Business Practice Location Address Fax Number:
818-893-5510
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KERSWILL
Authorized Official First Name:
GERD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
805-371-9988

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  9800879 , 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: HHA57514F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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