=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851930861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEB HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2019
-----------------------------------------------------
Last Update Date | 12/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 453 W SAN CARLOS ST STE 1
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95110-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-320-5289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 453 W SAN CARLOS ST STE 1
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95110-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CPO
-----------------------------------------------------
Name | ELLIS HIROKI BUTTERFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-407-5858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------