1679509228 NPI number — NORTHSHORE INVESTMENTS, INC.

Table of content: (NPI 1679509228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679509228 NPI number — NORTHSHORE INVESTMENTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSHORE INVESTMENTS, 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:
CRESCENT CITY NURSING & REHABILITATION CENTER
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:
1679509228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1280 MARSHALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESCENT CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95531-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-464-6151
Provider Business Mailing Address Fax Number:
707-464-6064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1280 MARSHALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-464-6151
Provider Business Practice Location Address Fax Number:
707-464-6064
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
ADMINISTRATOR/OWNER
Authorized Official Telephone Number:
707-464-6151

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 343900000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: ZZR06296L , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MTN00826F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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