Provider Demographics
NPI:1548548795
Name:BIGHORN HEARING AID CENTER, INC
Entity type:Organization
Organization Name:BIGHORN HEARING AID CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:760-625-6616
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:RRANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-625-6616
Mailing Address - Fax:760-346-1422
Practice Address - Street 1:39000 BOB HOPE DRIVE
Practice Address - Street 2:PROBST 202
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-625-6616
Practice Address - Fax:760-346-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7407237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty