1639527518 NPI number — PARTNERS PROJECT, INC.

Table of content: (NPI 1639527518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639527518 NPI number — PARTNERS PROJECT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS PROJECT, 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:
SOBER PARTNERS REEF HOUSE
Provider Other Organization Name Type Code:
3
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:
1639527518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3419 VIA LIDO
Provider Second Line Business Mailing Address:
#241
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-3908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-997-2786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 ALABAMA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92648-5265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-997-2786
Provider Business Practice Location Address Fax Number:
949-877-0119
Provider Enumeration Date:
06/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RAFFA
Authorized Official First Name:
SCOFF
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
949-873-3885

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  300305CP , 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)





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