1508819020 NPI number — STAFF ASSISTANCE, INC.

Table of content: MORGAN ELIZABETH TEETERS MS RDN LD CLC (NPI 1780205898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508819020 NPI number — STAFF ASSISTANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAFF ASSISTANCE, 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:
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:
1508819020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 MOODY COURT SUITE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91360-6067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-371-9988
Provider Business Mailing Address Fax Number:
805-371-9987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 MOODY COURT
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91360-6067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-379-3031
Provider Business Practice Location Address Fax Number:
805-371-9880
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KERSWILL
Authorized Official First Name:
GERD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
805-371-9988

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  9800879 , 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: HHA57514F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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