Provider Demographics
NPI:1093192973
Name:EXPERIENCE HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:EXPERIENCE HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:HALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-596-8824
Mailing Address - Street 1:2644 M ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2826
Mailing Address - Country:US
Mailing Address - Phone:925-350-4996
Mailing Address - Fax:
Practice Address - Street 1:2644 M ST
Practice Address - Street 2:SUITE F
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2826
Practice Address - Country:US
Practice Address - Phone:925-305-4996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2995171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT2995OtherBOARD OF MEDICAL QUALITY ASSURANCE PHYSICAL THERAPY