1851401251 NPI number — G AND E HEALTHCARE SERVICES, LLC

Table of content: (NPI 1851401251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851401251 NPI number — G AND E HEALTHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G AND E HEALTHCARE SERVICES, 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:
1851401251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 S FAIR OAKS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-304-6900
Provider Business Mailing Address Fax Number:
626-564-2617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14040 ASTORIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-367-5881
Provider Business Practice Location Address Fax Number:
818-362-1350
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MERCADO
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
626-304-6900

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  920000004 , 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: ZZT06084H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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