Healthcare Provider Details

I. General information

NPI: 1598397960
Provider Name (Legal Business Name): BILLET ADHC INC NEEDLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 FRONT ST
NEEDLES CA
92363-2739
US

IV. Provider business mailing address

6710 N 47TH AVE
GLENDALE AZ
85301-4121
US

V. Phone/Fax

Practice location:
  • Phone: 833-224-5538
  • Fax:
Mailing address:
  • Phone: 833-224-5538
  • Fax: 833-424-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VAHAN OGANESYAN
Title or Position: COO
Credential:
Phone: 833-224-5538