Provider Demographics
NPI:1821159682
Name:TAKECARE INSURANCE CO, INC.
Entity Type:Organization
Organization Name:TAKECARE INSURANCE CO, INC.
Other - Org Name:FHP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-646-5825
Mailing Address - Street 1:P.O. BOX 6578
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-6578
Mailing Address - Country:US
Mailing Address - Phone:671-646-6956
Mailing Address - Fax:671-647-3556
Practice Address - Street 1:OLEAL BUSINESS CENTER 1ST FLR.
Practice Address - Street 2:STE. 108-112
Practice Address - City:SAN JOSE
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-235-1006
Practice Address - Fax:671-647-3556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAKECARE INSURANCE CO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MPRP002183500000X
MP12137-0002302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU5428950OtherNCPDP #
GU5428950OtherNCPDP