1548590136 NPI number — TAHOE TRIO LLC DBA RIGHT AT HOME

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 1548590136 NPI number — TAHOE TRIO LLC DBA RIGHT AT HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAHOE TRIO LLC DBA RIGHT AT HOME
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:
1548590136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9375 ARCHIBALD AVE
Provider Second Line Business Mailing Address:
SUITE 312
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-5729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-466-5472
Provider Business Mailing Address Fax Number:
909-466-5874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9375 ARCHIBALD AVE
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-5729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-466-5472
Provider Business Practice Location Address Fax Number:
909-466-5874
Provider Enumeration Date:
01/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFERS
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
NEIL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-466-5472

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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