Provider Demographics
NPI:1942692439
Name:A.C. ADDERSON HEALTHCARE, INC.
Entity Type:Organization
Organization Name:A.C. ADDERSON HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PFEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-737-2055
Mailing Address - Street 1:1267 ENTERPRISE CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7126
Mailing Address - Country:US
Mailing Address - Phone:951-737-2055
Mailing Address - Fax:951-737-1223
Practice Address - Street 1:1267 ENTERPRISE CT
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7126
Practice Address - Country:US
Practice Address - Phone:951-737-2055
Practice Address - Fax:951-737-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1253020001Medicare PIN