1518248947 NPI number — MENTAL HEALTH SYSTEM SUCCESS FIRST

Table of content: MARK PHILIP MICHALOWSKI RPH (NPI 1750983102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518248947 NPI number — MENTAL HEALTH SYSTEM SUCCESS FIRST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH SYSTEM SUCCESS FIRST
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:
1518248947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9087 ARROW RTE
Provider Second Line Business Mailing Address:
150
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-4450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-980-2789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9087 ARROW RTE
Provider Second Line Business Practice Location Address:
150
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-4450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-980-2789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DEAN
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
909-980-2789

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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