1841358561 NPI number — YWCA BORN FREE

Table of content: NIRMALA GOLDER MS,RD, CDN (NPI 1598200958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841358561 NPI number — YWCA BORN FREE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YWCA BORN FREE
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:
1841358561
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:
8172 MAGNOLIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-687-9922
Provider Business Mailing Address Fax Number:
951-352-7374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8310 BAXTER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-689-9366
Provider Business Practice Location Address Fax Number:
951-352-7374
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RHODES
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
951-687-9922

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  330015CN , 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: 33352 . This is a "MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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