1780869966 NPI number — NEIGHBORHOOD HEALTHCARE

Table of content: (NPI 1780869966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780869966 NPI number — NEIGHBORHOOD HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORHOOD HEALTHCARE
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:
1780869966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 N DATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92025-3413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-737-2035
Provider Business Mailing Address Fax Number:
760-520-8314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41715 WINCHESTER RD
Provider Second Line Business Practice Location Address:
SUITE 203 & 204
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92590-4854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-600-6300
Provider Business Practice Location Address Fax Number:
951-600-6306
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
REAM
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-520-8375

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BCP70563G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HAP70563G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FHC70563G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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