1295281103 NPI number — STORMS WELLNESS CENTER

Table of content: (NPI 1295281103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295281103 NPI number — STORMS WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STORMS WELLNESS CENTER
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:
1295281103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 OAK PARK BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94523-4479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-945-7890
Provider Business Mailing Address Fax Number:
925-945-8691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 OAK PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94523-4479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-945-7890
Provider Business Practice Location Address Fax Number:
925-945-8691
Provider Enumeration Date:
08/31/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STORMS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
925-945-7890

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC16493 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174V00000X , with the licence number: Z23453 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: 58058 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: 989463 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: 581938 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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