1902214679 NPI number — A BETTER CHOICE FAMILY PRACTICE, LLC

Table of content: (NPI 1902214679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902214679 NPI number — A BETTER CHOICE FAMILY PRACTICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A BETTER CHOICE FAMILY PRACTICE, 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:
1902214679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 W COMBS RD
Provider Second Line Business Mailing Address:
SUITE 101-196
Provider Business Mailing Address City Name:
SAN TAN VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85140-9105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-986-4300
Provider Business Mailing Address Fax Number:
480-986-4300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20851 E RITTENHOUSE RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
QUEEN CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85142-4493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-986-4300
Provider Business Practice Location Address Fax Number:
480-986-4300
Provider Enumeration Date:
07/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HARDING
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
LEANN
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
970-396-4545

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP4673 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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