Provider Demographics
NPI:1447584297
Name:NEIGHBORHOOD HEALTHCARE
Entity type:Organization
Organization Name:NEIGHBORHOOD HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:REAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-737-2030
Mailing Address - Street 1:855 E MADISON AVE
Mailing Address - Street 2:#101
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3819
Mailing Address - Country:US
Mailing Address - Phone:760-737-2025
Mailing Address - Fax:
Practice Address - Street 1:855 E MADISON AVE # 101
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3819
Practice Address - Country:US
Practice Address - Phone:760-737-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50043333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5635959OtherNCPDP PROVIDER IDENTIFICATION NUMBER