Provider Demographics
NPI:1316698525
Name:CONGREGATION PIRCHEI SHOSHANIM
Entity type:Organization
Organization Name:CONGREGATION PIRCHEI SHOSHANIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-538-8111
Mailing Address - Street 1:24000 ALICIA PARKWAY
Mailing Address - Street 2:STE 17, BOX 234
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-215-9995
Mailing Address - Fax:
Practice Address - Street 1:26576 AVENIDA DESEO
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3304
Practice Address - Country:US
Practice Address - Phone:949-538-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals