1417768144 NPI number — OUR COMMUNITY, OUR SENIORS

Table of content: MS. KAREN LOUISE MALLOW CNP (NPI 1396786034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417768144 NPI number — OUR COMMUNITY, OUR SENIORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR COMMUNITY, OUR SENIORS
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:
1417768144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14624B LAKESHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARLAKE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95422-8490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-701-1557
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14624B LAKESHORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARLAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95422-8490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-701-1557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2025

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINS
Authorized Official First Name:
CAMILLE
Authorized Official Middle Name:
MONAE
Authorized Official Title or Position:
CHW COORDINATOR, FOUNDER
Authorized Official Telephone Number:
707-701-1557

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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