Basic Information
| Provider Information | |||||||||
| NPI: | 1700528155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACTIVATE HEALTHCARE LOCAL 357 ORANGE | ||||||||
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| Address1: | 4651 CHARLOTTE PARK DR STE 300 | ||||||||
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| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282171916 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 283 N PECOS RD | ||||||||
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| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890741918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046611380 | ||||||||
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| ProviderEnumerationDate: | 04/07/2022 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | PATTON | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | JOHNSON | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF RISK MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 7049365546 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0500X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
No ID Information.