1437171543 NPI number — LOMI SCHOOL FOUNDATION

Table of content: (NPI 1437171543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437171543 NPI number — LOMI SCHOOL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOMI SCHOOL FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOMI PSYCHOTHERAPY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437171543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 10TH ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95401-5291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-579-0465
Provider Business Mailing Address Fax Number:
707-579-0560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 10TH ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95401-5291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-579-0465
Provider Business Practice Location Address Fax Number:
707-579-0560
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWEENEY
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
707-579-0465

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  306494090 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 61-31568 . This is a "UNITED HEALTHCARE SERVICE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com