1639632763 NPI number — ACUTE CARE

Table of content: (NPI 1639632763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639632763 NPI number — ACUTE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACUTE CARE
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:
1639632763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 E MARIPOSA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL SEGUNDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90245-5029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-426-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 E MARIPOSA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL SEGUNDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90245-5029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-426-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MAYES
Authorized Official First Name:
RAVEN
Authorized Official Middle Name:
SHENETTE
Authorized Official Title or Position:
DOCTOR OF OPTOMETRY
Authorized Official Telephone Number:
352-792-8069

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3791208-11-15-2012 . This is a "CARDIAC RHYTHMS: SINUS RHYTHMS (NURSING)" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3812493-06-19-2013 . This is a "GOVERNMENT ETHICS - THE ESSENTIALS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 8585-10-05-2011 . This is a "HIV/AIDS: AVOIDING INFECTION" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1333994-10-04-2011 . This is a "MAND: EMERGENCY MANAGEMENT PLAN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1337035-10-04-2011 . This is a "IMPAIRED PROFESSIONALS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1339073-10-05-2011 . This is a "BLS (BASIC LIFE SUPPORT) HEALTHCARE PROVIDER COURSE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3782242-10-17-2013 . This is a "PROTECTING AGAINST BLOODBORNE PATHOGENS NURSING" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3832153-10-31-2012 . This is a "FIT TESTING" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 7318-10-04-2011 . This is a "COMPLIANCE AND BUSINESS INTEGRITY (CBI) AWARENESS MANDATORY EDUCATION COURSE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1324114-10-05-2011 . This is a "VISN 8 DIVERSITY TRAINING" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 11754-10-18-2013 . This is a "PATIENT LEGAL RIGHTS, PROTECTION FROM ABUSE NURSE AIDE NURSE ASSISTANT" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 8872-10-05-2011 . This is a "PREVENTION OF WORKPLACE HARASSMENT/NO FEAR" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1337011-10-17-2013 . This is a "DOMESTIC VIOLENCE FBN2285" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1337015-10-17-2013 . This is a "PREVENTION OF MEDICAL ERRORS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1339075-10-05-2011 . This is a "BLS (BASIC LIFE SUPPORT) HEALTHCARE PROVIDER RENEWAL TRAINING" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 8586-12-05-2011 . This is a "HIV/AIDS: GENERAL INFORMATION" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1333993-01-12-2012 . This is a "MAND: CULTURALLY COMPETENT HEALTH CARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3813340-11-15-2012 . This is a "CARDIAC RHYTHMS: ATRIAL RHYTHMS (NURSING)" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1324101-10-05-2011 . This is a "VISN 8 CULTURAL COMPETENCY" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 1333999-01-12-2012 . This is a "MAND: FIRE AND SAFETY" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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