1376596742 NPI number — RCOA-ADVENTIST HEALTH, LLC

Table of content: (NPI 1376596742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376596742 NPI number — RCOA-ADVENTIST HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RCOA-ADVENTIST HEALTH, LLC
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:
1376596742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 85001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32885-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-293-3500
Provider Business Mailing Address Fax Number:
866-293-3535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 GREENLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-293-3500
Provider Business Practice Location Address Fax Number:
866-293-3535
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
DERRICK
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VP OF ACCOUNTING AND FINANCE
Authorized Official Telephone Number:
561-477-3500

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X , with the licence number:  6838-17 , 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: ZZZ66592Z . This is a "BS OF CA PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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