1528433588 NPI number — LIVINGSTON COMMUNITY HEALTH

Table of content: (NPI 1528433588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528433588 NPI number — LIVINGSTON COMMUNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIVINGSTON COMMUNITY HEALTH
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:
1528433588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95334-1257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-394-7913
Provider Business Mailing Address Fax Number:
209-394-3660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12619 BENTLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95386-9011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-442-6200
Provider Business Practice Location Address Fax Number:
209-394-9093
Provider Enumeration Date:
12/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MCGOWAN
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
209-394-7913

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 751901 . This is a "MEDICARE OSCAR/CERTIFICATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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