Healthcare Provider Details

I. General information

NPI: 1043305840
Provider Name (Legal Business Name): PRINCIPAL-NEEDLES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BAILEY AVE
NEEDLES CA
92363-3103
US

IV. Provider business mailing address

103 POWELL CT
BRENTWOOD TN
37027-5079
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-4531
  • Fax: 760-326-4532
Mailing address:
  • Phone: 615-372-8500
  • Fax: 615-372-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number240000227
License Number StateCA

VIII. Authorized Official

Name: DAVID M. DILL
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8500