1760491625 NPI number — NEW COVENANT CARE OF DINUBA INC

Table of content: (NPI 1760491625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760491625 NPI number — NEW COVENANT CARE OF DINUBA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW COVENANT CARE OF DINUBA 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:
NEW COVENANT CARE CENTER OF DINUBA
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:
1760491625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2540 CAMINO DIABLO
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94597-3950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-937-7400
Provider Business Mailing Address Fax Number:
925-937-0217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1730 S. COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DINUBA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
83618-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-591-3300
Provider Business Practice Location Address Fax Number:
559-591-0705
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEDLALAK
Authorized Official First Name:
DEWAYNE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
SECRETARY/CFO
Authorized Official Telephone Number:
525-937-7400

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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