1790562072 NPI number — HEALTHCARE SERVICES, INC.

Table of content: (NPI 1790562072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790562072 NPI number — HEALTHCARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE SERVICES, 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:
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:
1790562072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 KALMUS DR STE K1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COSTA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92626-5975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-384-3339
Provider Business Mailing Address Fax Number:
714-384-3879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 W PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92801-5943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-780-1174
Provider Business Practice Location Address Fax Number:
714-388-3697
Provider Enumeration Date:
09/11/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
714-384-3339

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300188GP . This is a "DEPARTMENT OF HEALTHCARE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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