Provider Demographics
NPI:1689714198
Name:THE HEALTH TRUST
Entity Type:Organization
Organization Name:THE HEALTH TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-513-8700
Mailing Address - Street 1:1400 PARKMOOR AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3798
Mailing Address - Country:US
Mailing Address - Phone:408-961-9854
Mailing Address - Fax:408-961-9856
Practice Address - Street 1:46 RACE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3130
Practice Address - Country:US
Practice Address - Phone:408-961-9845
Practice Address - Fax:408-961-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251X00000X
CAG91493-01251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAYD000090OtherMEDICAL PIN
CAG91493-01Medicare UPIN
CAAYD000090OtherMEDICAL PIN
CAG91493-02Medicare UPIN