1972557197 NPI number — SALUSCARE, INC.

Table of content: (NPI 1972557197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972557197 NPI number — SALUSCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALUSCARE, 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:
1972557197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3763 EVANS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33901-9302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-275-3222
Provider Business Mailing Address Fax Number:
239-332-0287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3763 EVANS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-308-1289
Provider Business Practice Location Address Fax Number:
239-332-0287
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
239-275-3222

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 284300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3245S0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008622205 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060269833 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008622202 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008622203 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008622200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008622201 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060269800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060269802 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060269804 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060269838 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103250800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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