1477979789 NPI number — GOLD COUNTRY TELECARE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477979789 NPI number — GOLD COUNTRY TELECARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLD COUNTRY TELECARE, 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:
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:
1477979789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2161
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRASS VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95945-2161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-272-1710
Provider Business Mailing Address Fax Number:
530-274-3210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 LITTON DR
Provider Second Line Business Practice Location Address:
SUITE 327
Provider Business Practice Location Address City Name:
GRASS VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95945-5036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-272-1710
Provider Business Practice Location Address Fax Number:
530-274-3210
Provider Enumeration Date:
03/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KUHN
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
530-272-1710

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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