1023848637 NPI number — PAYNE FAMILY NURSING AND WELLNESS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023848637 NPI number — PAYNE FAMILY NURSING AND WELLNESS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAYNE FAMILY NURSING AND WELLNESS INC
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:
Provider Other Organization Name Type Code:
6
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:
1023848637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19069 VAN BUREN BLVD STE 114
Provider Second Line Business Mailing Address:
PMB 491
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92508-2548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-543-7712
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 CORPORATE TERRACE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92879-6028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-543-7712
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
PAYNE
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
951-543-7712

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WW0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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