1457638140 NPI number — GOLDEN AGE SENIOR CARE OF CAMBRIA

Table of content: DEBORAH A. SCATTARELLI CNP (NPI 1427001130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457638140 NPI number — GOLDEN AGE SENIOR CARE OF CAMBRIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN AGE SENIOR CARE OF CAMBRIA
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:
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:
1457638140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 S WACKER DR
Provider Second Line Business Mailing Address:
SUITE 1800
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60606-4424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-357-1601
Provider Business Mailing Address Fax Number:
312-357-1611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 SAUL KLEINFELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936-3757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-857-5487
Provider Business Practice Location Address Fax Number:
915-857-7404
Provider Enumeration Date:
11/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
312-521-7600

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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