Debra Ballou-Harding specialises in Assisted Living, Mental Illness. currently works in California.
| NPI Number | 1487314647 |
| Provider Name | Debra Ballou-Harding |
| Credential | |
| Specialization | Assisted Living, Mental Illness |
| Medical School Name | |
| Graduation Year | |
| Gender | |
| Entity Type | Individual |
| PAC ID by PECOS | |
| Professional Enrollment ID | |
| Enumeration Date | 12/28/2021 |
| Last Update Date | 12/28/2021 |
| Business Practice address |
14516 TACUBA DR, La Mirada, 90638-2043 California View on Google Map |
| Business Practice phone | 562-805-0526 |
| Business Practice fax | |
| Mailing address |
17906 CANEHILL AVE, Bellflower, 90706-7149 California View on Google Map |
| Other phone | 310-650-0545 |
| Other fax | |
| Email Address | shannonfig@domain.com Reval Email Address |
Practices in La Mirada
La Mirada, California
| Field Name | Field Value |
|---|---|
| NPI | 1487314647 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
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| Is Sole Proprietor | Y |
Indicate whether provider is a sole proprietor.
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| Provider Last Name (Legal Name) | Ballou-Harding |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Debra |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | 17906 CANEHILL AVE |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Bellflower |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | California |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 90706-7149 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 310-650-0545 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider First Line Business Practice Location Address | 14516 TACUBA DR |
| The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. | |
| Provider Business Practice Location Address City Name | La Mirada |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | California |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 90638-2043 |
| The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
| Provider Business Practice Location Address Country Code | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 562-805-0526 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 12/28/2021 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 12/28/2021 |
| The date that a record was last updated or changed. | |
| Healthcare Provider Taxonomy Code #1 | 3104A0625X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Healthcare Provider Taxonomy #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #2 | 311ZA0620X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Healthcare Provider Taxonomy #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #3 | 320600000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 3 | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. |
| Healthcare Provider Taxonomy #3 | |
| Healthcare Provider Primary Taxonomy Switch 3 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #4 | 3104A0630X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 4 | A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |
| Healthcare Provider Taxonomy #4 | |
| Healthcare Provider Primary Taxonomy Switch 4 | Y |
Primary Taxonomy:
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