Provider Demographics
NPI:1114557857
Name:AMVI CARE HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:AMVI CARE HEALTH NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-708-3230
Mailing Address - Street 1:600 CITY PKWY W STE 800
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2948
Mailing Address - Country:US
Mailing Address - Phone:800-708-3230
Mailing Address - Fax:
Practice Address - Street 1:600 CITY PKWY W STE 800
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2948
Practice Address - Country:US
Practice Address - Phone:800-708-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization