Healthcare Provider Details

I. General information

NPI: 1629333000
Provider Name (Legal Business Name): NORTHLAND HEARING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SIMI TOWN CENTER WAY SUITE #3
SIMI VALLEY CA
93065-8405
US

IV. Provider business mailing address

2510 E SUNSET RD UNIT 5-260
LAS VEGAS NV
89120-3511
US

V. Phone/Fax

Practice location:
  • Phone: 805-579-9324
  • Fax: 805-579-9647
Mailing address:
  • Phone: 702-798-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2556601
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2556601
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY LONGTAIN
Title or Position: PRESIDENT
Credential:
Phone: 702-798-0113