1659445203 NPI number — PHILMAR CARE LLC

Table of content: (NPI 1659445203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659445203 NPI number — PHILMAR CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILMAR CARE LLC
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:
1659445203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16742 ORANGE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FONTANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92335-3809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-987-7735
Provider Business Mailing Address Fax Number:
909-484-6809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12260 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-899-9545
Provider Business Practice Location Address Fax Number:
818-890-2142
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREENWELL
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
909-987-7735

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  920000031 , 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: LTC55814F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC70160F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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