Basic Information
Provider Information | |||||||||
NPI: | 1598209769 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ACCOUNTABLE CARE POST ACUTE CARE SERVICES LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ACCOUNTABLE CARE POST ACUTE CARE | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1155 S CONGRESS AVE STE C | ||||||||
Address2: |   | ||||||||
City: | PALM SPRINGS | ||||||||
State: | FL | ||||||||
PostalCode: | 334065114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177661300 | ||||||||
FaxNumber: | 5616930539 | ||||||||
Practice Location | |||||||||
Address1: | 1155 S CONGRESS AVE STE C | ||||||||
Address2: |   | ||||||||
City: | PALM SPRINGS | ||||||||
State: | FL | ||||||||
PostalCode: | 334065114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617661300 | ||||||||
FaxNumber: | 5616930539 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/07/2016 | ||||||||
LastUpdateDate: | 11/04/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GHIRAGOSSIAN | ||||||||
AuthorizedOfficialFirstName: | JORGE | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 5617661300 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/04/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.