Provider Demographics
NPI:1538568977
Name:EASTER SEAL SOCIETY OF SUPERIOR CALIFORNIA
Entity type:Organization
Organization Name:EASTER SEAL SOCIETY OF SUPERIOR CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-485-6711
Mailing Address - Street 1:3205 HURLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3853
Mailing Address - Country:US
Mailing Address - Phone:916-679-3108
Mailing Address - Fax:916-485-2653
Practice Address - Street 1:3205 HURLEY WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-9586
Practice Address - Country:US
Practice Address - Phone:916-485-6711
Practice Address - Fax:916-485-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 21514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty