1548563323 NPI number — GREENWOOD CENTER INC

Table of content: (NPI 1548563323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548563323 NPI number — GREENWOOD CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWOOD CENTER 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:
1548563323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15550 ROCKFIELD BLVD
Provider Second Line Business Mailing Address:
B220
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-2720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-598-9999
Provider Business Mailing Address Fax Number:
949-598-9990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41555 CHERRY ST
Provider Second Line Business Practice Location Address:
SUITE# A
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-600-0550
Provider Business Practice Location Address Fax Number:
951-600-9037
Provider Enumeration Date:
12/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWOOD
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
951-600-0550

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC20986 , 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: 1205053493 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC0209860 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC20986 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BS539A . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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