1174693493 NPI number — THE WECARE GROUP, INC.

Table of content: (NPI 1174693493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174693493 NPI number — THE WECARE GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WECARE GROUP, 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:
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:
1174693493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95565-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-764-5617
Provider Business Mailing Address Fax Number:
707-783-5618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 VAN DUZEN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAD RIVER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95552-0004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-574-6616
Provider Business Practice Location Address Fax Number:
707-574-6523
Provider Enumeration Date:
11/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUPTON
Authorized Official First Name:
GRAYLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
707-574-6616

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2300000060 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , with the licence number: 230000060 , 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: RHM70040F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FHC70040F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".