1396747762 NPI number — SHOVA HEALTHCARE VNA, LLC

Table of content: (NPI 1396747762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396747762 NPI number — SHOVA HEALTHCARE VNA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHOVA HEALTHCARE VNA, 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:
1396747762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 W FLORIDA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEMET
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92543-3814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-791-1111
Provider Business Mailing Address Fax Number:
951-925-3606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27851 BRADLEY RD
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92586-2286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-675-4829
Provider Business Practice Location Address Fax Number:
951-679-3944
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHAUDHURI
Authorized Official First Name:
KALI
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
951-791-1111

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  250000225 , 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: HHA07774F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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