1083609853 NPI number — PRIORITY ONE HOME HEALTH SERVICES INC

Table of content: (NPI 1083609853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083609853 NPI number — PRIORITY ONE HOME HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY ONE HOME HEALTH SERVICES 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:
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:
1083609853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4959 PALO VERDE ST
Provider Second Line Business Mailing Address:
SUITE 108-C
Provider Business Mailing Address City Name:
MONTCLAIR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91763-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-625-6377
Provider Business Mailing Address Fax Number:
909-625-6077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4959 PALO VERDE ST
Provider Second Line Business Practice Location Address:
SUITE 108-C
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-625-6377
Provider Business Practice Location Address Fax Number:
909-625-6077
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CATUIRA
Authorized Official First Name:
MARIA CHONA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DPCS ADMINISTRATOR
Authorized Official Telephone Number:
909-625-6377

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  240000768 , 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: HHA08063F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com