1497364004 NPI number — OWEN HEALTH CARE, INC

Table of content: (NPI 1497364004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497364004 NPI number — OWEN HEALTH CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OWEN HEALTH CARE, 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:
1497364004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2041 SPRINGFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAUXHALL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07088-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-258-7796
Provider Business Mailing Address Fax Number:
908-258-7798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2041 SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAUXHALL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07088-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-258-7796
Provider Business Practice Location Address Fax Number:
908-258-7798
Provider Enumeration Date:
07/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ERO
Authorized Official First Name:
CHRISTIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
908-258-7796

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0746932 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com