1376935833 NPI number — C & C HEARING HEALTH, LLC

Table of content: (NPI 1376935833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376935833 NPI number — C & C HEARING HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C & C HEARING 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:
1376935833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73131 COUNTRY CLUB DR
Provider Second Line Business Mailing Address:
C5
Provider Business Mailing Address City Name:
PALM DESERT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92260-2339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-568-1300
Provider Business Mailing Address Fax Number:
760-568-1270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73131 COUNTRY CLUB DR
Provider Second Line Business Practice Location Address:
C5
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92260-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-568-1300
Provider Business Practice Location Address Fax Number:
760-568-1270
Provider Enumeration Date:
02/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ERICKSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
760-568-1300

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X , with the licence number:  HA 7892 , 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: HA 7892 . This is a "CA- HEARING AID DISPENSER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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