1689912032 NPI number — 1ST STEP APPLIED BEHAVIOR ANALYSTS, INC

Table of content: (NPI 1689912032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689912032 NPI number — 1ST STEP APPLIED BEHAVIOR ANALYSTS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1ST STEP APPLIED BEHAVIOR ANALYSTS, 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:
Provider Other Organization Name Type Code:
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:
1689912032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHINGLE SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95682-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-712-7395
Provider Business Mailing Address Fax Number:
530-677-5443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3107 ALHAMBRA DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CAMERON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95682-7688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-712-7395
Provider Business Practice Location Address Fax Number:
530-677-5443
Provider Enumeration Date:
01/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VANDENBERG
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
530-748-9395

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1073547 , 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: 1104128362 . This is a "BEHAVIOR HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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