1679920136 NPI number — LOS NINO'S DAY CARE OF CATALINA LLC

Table of content: (NPI 1679920136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679920136 NPI number — LOS NINO'S DAY CARE OF CATALINA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS NINO'S DAY CARE OF CATALINA 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:
MARY & PETE'S ASSISTED LIVING
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:
1679920136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 74
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MANUEL
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85631-0074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-909-3241
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 E AVENUE I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MANUEL
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85631-1357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-909-3241
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALES
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
520-400-4217

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL9394H , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004189 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com