JACK WANG (NPI# 1467817825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467817825 |
| Entity Type | Individual |
| Full Name | JACK WANG |
| Practice Address |
1821 N Trekell Rd Ste 7 Casa Grande AZ 85122-1705 |
| Mailing Address |
1821 N Trekell Rd Ste 7 Casa Grande AZ 85122-1705 |
| Practice Telephone | 5208769293 |
| Practice Fax Number | 5208769334 |
| Mailing Telephone | 5208769293 |
| Mailing Fax Number | 5208769334 |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2015-12-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639702327 | Jack Wang | Pharmacist | 1980 College Blvd, Oceanside, CA 92056-5939 | 2020-02-20 |
| 1154733053 | Jack Tzu-chieh Wang | Psychiatry & Neurology | 300 Pasteur Dr, Stanford, CA 94305-2200 | 2014-05-27 |
| 1508191164 | Jack Chengjie Wang | Student in an Organized Health Care Education/Training Program | 8901 Wisconsin Ave, Bethesda, MD 20889-5600 | 2009-10-14 |
| 1740272368 | Jack Z Wang | Radiology | 1700 Clinton St, Hackley Cancer Center, Muskegon, MI 49442-5502 | 2005-08-19 |
| Street Address |
1821 N TREKELL RD STE 7 |
| City | CASA GRANDE |
| State | AZ |
| Zip Code | 85122-1705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316983281 | Summit Rehabilitation | Clinic/Center | 1821 N Trekell Rd, Suite 8, Casa Grande, AZ 85222-1705 | 2006-06-21 |
| 1528513751 | Pete Vavages | Peer Specialist | 1821 N Trekell Rd, Suite 7, Casa Grande, AZ 85122-1705 | 2016-08-17 |
| 1902256035 | Nicole Moraga | Case Manager/Care Coordinator | 1821 N Trekell Rd, Suite 7, Casa Grande, AZ 85122-1705 | 2016-06-20 |
| 1982063905 | Francisca Federico | Case Manager/Care Coordinator | 1821 N Trekell Rd, Suite 7, Casa Grande, AZ 85122-1705 | 2016-02-18 |
| 1043675408 | James Zbell | Registered Nurse | 1821 N Trekell Rd, Ste 7, Casa Grande, AZ 85122-1705 | 2015-12-29 |
| 1982069340 | Andres L Salazar | Peer Specialist | 1821 N Trekell Rd, Ste 7, Casa Grande, AZ 85122-1705 | 2015-12-29 |
| 1285004135 | Frances Archuleta | Counselor | 1821 N Trekell Rd, Suite 7, Casa Grande, AZ 85122-1705 | 2015-10-05 |
| 1144602988 | Kathy Brock | Registered Nurse | 1821 N Trekell Rd, Suite 7, Casa Grande, AZ 85122-1705 | 2015-06-28 |
| 1811389257 | Carrie Freeland | Registered Nurse | 1821 N Trekell Rd, Casa Grande, AZ 85122-1705 | 2015-02-23 |
| 1356746762 | Telecare Mental Health Services of Arizona, Inc | Clinic/Center | 1821 N Trekell Rd, Suite 7, Casa Grande, AZ 85122-1705 | 2014-10-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043857097 | Karen M Garcia | Registered Nurse | 2631 N Brown Avenue, Casa Grande, AZ 85122 | 2019-12-09 |
| 1063060291 | Martha Bollin | Registered Nurse | 2631 N. Brown Ave., Casa Grande, AZ 85122 | 2019-08-30 |
| 1841846920 | Banner Imaging Services LLC | Radiology | 1828 E. Florence Blvd Bldg B Ste 118 & 128, Suite 118 and 128, Casa Grande, AZ 85122 | 2019-08-14 |
| 1629532692 | Kirk Lee Mackley | Physical Therapist | Vibrant Care, 1355 E Florence Blvd #137, Casa Grande, AZ 85122 | 2019-01-24 |
| 1205307436 | Natalie T Trujillo | Physician Assistant | 301 E Cottonwood Ln Ste 1&2, Casa Grande, AZ 85122 | 2018-12-16 |
| 1710455860 | Community Intervention Associates, Inc | Clinic/Center | 1667 N. Trekell Rd, Suite 101 & 102, Casa Grande, AZ 85122 | 2018-11-07 |
| 1245728302 | Jenkins Chiropractic LLC | Chiropractor | 1891 N Trekell Rd Ste 2, Casa Grande, AZ 85122 | 2018-04-24 |
| 1497242408 | Kelly Winnett | Naturopath | 1415 N Trekell Rd Ste 102, Casa Grande, AZ 85122 | 2018-04-16 |
| 1851895783 | Michael Brubaker Counseling | Community/Behavioral Health | 1927 N. Trekell Rd, Ste D, Casa Grande, AZ 85122 | 2018-03-23 |
| 1770095317 | Walmart Stores Inc. | Pharmacy | 1741 E. Florence Blvd, Casa Grande, AZ 85122 | 2017-11-03 |
| Find all providers in zip 85122 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861884157 | Valena F Eisenhart | Peer Specialist | 1745 N Kadota Ave, Casa Grande, AZ 85122-2131 | 2015-02-24 |
| 1528513751 | Pete Vavages | Peer Specialist | 1821 N Trekell Rd, Suite 7, Casa Grande, AZ 85122-1705 | 2016-08-17 |
| 1982069340 | Andres L Salazar | Peer Specialist | 1821 N Trekell Rd, Ste 7, Casa Grande, AZ 85122-1705 | 2015-12-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679181457 | Justin David Lee Harvey | Peer Specialist | 1616 E Main St Ste 207a-1, Mesa, AZ 85203-9071 | 2020-07-17 |
| 1689295636 | Native Music Coalition | Peer Specialist | 4814 S Warren Ave, Tucson, AZ 85714-1749 | 2020-04-30 |
| 1063031532 | Grace Irene Tang | Peer Specialist | 3023 N Calle Castellon, Tucson, AZ 85745-9512 | 2020-04-14 |
| 1407493687 | Vincent Merced Flores | Peer Specialist | 1706 E Calle Salamanca, Tucson, AZ 85714-1729 | 2019-12-05 |
| 1043737497 | Penny Pulz Golf LLC | Peer Specialist | 10315 W Wininger Cir Ste B, Sun City, AZ 85351-4758 | 2017-08-26 |
| 1275917379 | Diedra Y Kinne | Peer Specialist | 240 West Jensen St., Fredonia, AZ 86022-0491 | 2015-07-17 |
| 1578953477 | Vincent Nicasio Jr. | Peer Specialist | 471 N Marshall Loop Rd, Somerton, AZ 85350-6216 | 2015-01-29 |
| 1235737156 | Timothy Chakos-kender | Peer Specialist | 4343 N 16th St, Phoenix, AZ 85016-5338 | 2020-10-13 |
| 1518565696 | Aaron R Fry | Peer Specialist | 4343 N 16th St, Phoenix, AZ 85016-5338 | 2020-10-12 |
| 1508474917 | Chauncey Bradford | Peer Specialist | 1616 E Main St Ste 207a-1, Mesa, AZ 85203-9071 | 2020-07-21 |
| Find all providers with the same taxonomy | ||||
| City | CASA GRANDE |
| Zip Code | 85122 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.