1871007435 NPI number — HOPE DRUG REHABILITATION CENTER LLP

Table of content: DOUGLAS ESTRADA ND (NPI 1770047045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871007435 NPI number — HOPE DRUG REHABILITATION CENTER LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPE DRUG REHABILITATION CENTER LLP
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:
1871007435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5314 STEPHEN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROSS LANES
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25313-1159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-881-7928
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5257 BIG TYLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSS LANES
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25313-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-881-7928
Provider Business Practice Location Address Fax Number:
304-881-7928
Provider Enumeration Date:
11/18/2017

Additional Information

Authorized Official

Authorized Official Last Name:
EYA
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
304-881-7928

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com