1902821929 NPI number — PRAC HOLDINGS, INC.

Table of content: (NPI 1902821929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902821929 NPI number — PRAC HOLDINGS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAC HOLDINGS, INC.
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:
1902821929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 WARRENVILLE RD STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LISLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60532-0912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-3400
Provider Business Mailing Address Fax Number:
630-487-2713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1388 SUTTER STREET
Provider Second Line Business Practice Location Address:
STE. 904
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94109-5438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-474-1468
Provider Business Practice Location Address Fax Number:
415-474-1985
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
DARBY
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP, CHIEF STRATEGY OFFICER
Authorized Official Telephone Number:
630-296-3443

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  220000320 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HHA55-7580 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5577580 . This is a "BLUE CROSS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ03607Z . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com