1891473427 NPI number — ACERA HEALTH, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891473427 NPI number — ACERA HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACERA HEALTH, 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:
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:
1891473427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3843 S BRISTOL ST
Provider Second Line Business Mailing Address:
PMB #621
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92704-7426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-518-0628
Provider Business Mailing Address Fax Number:
949-386-2212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 SNOWDROP TREE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92606-4508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-336-4701
Provider Business Practice Location Address Fax Number:
949-386-2212
Provider Enumeration Date:
07/05/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HILGER
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
949-234-6250

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 306006255 . This is a "DSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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