1821469966 NPI number — PRIME HEALTHCARE SERVICES - SAINT CLARE'S LLC

Table of content: (NPI 1821469966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821469966 NPI number — PRIME HEALTHCARE SERVICES - SAINT CLARE'S LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME HEALTHCARE SERVICES - SAINT CLARE'S 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:
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:
1821469966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 E GUASTI RD
Provider Second Line Business Mailing Address:
THIRD FLOOR
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91761-8655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-235-4300
Provider Business Mailing Address Fax Number:
909-235-4419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MORRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07834-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-983-1524
Provider Business Practice Location Address Fax Number:
973-983-1688
Provider Enumeration Date:
10/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HEATHER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
909-235-4300

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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