1982891743 NPI number — ENTERAL PRODUCTS, LLC

Table of content: (NPI 1396493375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982891743 NPI number — ENTERAL PRODUCTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENTERAL PRODUCTS, 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:
1982891743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11333 GREENSTONE AVE
Provider Second Line Business Mailing Address:
A
Provider Business Mailing Address City Name:
SANTA FE SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90670-4618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-447-2550
Provider Business Mailing Address Fax Number:
562-968-5315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11333 GREENSTONE AVE
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
SANTA FE SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90670-4618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-447-2550
Provider Business Practice Location Address Fax Number:
562-968-5315
Provider Enumeration Date:
09/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RECHNITZ
Authorized Official First Name:
YISROEL
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
562-447-2550

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  1166 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: W002244 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: MG01187 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: CSW.0002888 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: DME18253 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 203001226 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 69000639A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 16-00392 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: HME00304 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: DME.000248 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: R3457 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 5306003903 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: F09620 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: PHA-WDD-LIC-1796 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 47578 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 535153 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982891743 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2117548 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982891743 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3095921 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982891743 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982891743 01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982891743 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982891743 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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