1710766670 NPI number — SWING CARE PROVIDER GROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710766670 NPI number — SWING CARE PROVIDER GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWING CARE PROVIDER GROUP, PC
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:
1710766670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 N BARRANCA AVE # 1801
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91723-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-667-7326
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 WINFIELD RD STE 200
Provider Second Line Business Practice Location Address:
#4321
Provider Business Practice Location Address City Name:
WARRENVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60555-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-667-7326
Provider Business Practice Location Address Fax Number:
877-349-1868
Provider Enumeration Date:
09/28/2023

Additional Information

Authorized Official

Authorized Official Last Name:
FRANK
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
Authorized Official Title or Position:
HEAD OF OPERATIONS
Authorized Official Telephone Number:
415-602-0855

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com