Healthcare Provider Details

I. General information

NPI: 1598910549
Provider Name (Legal Business Name): ARCADIAN HEALTH PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 12TH ST STE 300
OAKLAND CA
94607-4087
US

IV. Provider business mailing address

500 12TH ST STE 350
OAKLAND CA
94607-5204
US

V. Phone/Fax

Practice location:
  • Phone: 510-832-0311
  • Fax: 510-817-1894
Mailing address:
  • Phone: 510-832-0311
  • Fax: 510-817-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number12151
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number112421
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number166975
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number13794 (FOR AHP)
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberFILE NUMBER 933 0468
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number12151
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number103078
License Number StateNH
# 8
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number12151
License Number StateVA
# 9
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number174
License Number StateWA

VIII. Authorized Official

Name: MR. JAMES NOVELLO JR.
Title or Position: SR. VP AND GENERAL COUNSEL
Credential:
Phone: 510-817-1845