1942963442 NPI number — NIGHTWATER HEALTH OF CALIFORNIA APMC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942963442 NPI number — NIGHTWATER HEALTH OF CALIFORNIA APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIGHTWATER HEALTH OF CALIFORNIA APMC
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:
1942963442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 WATER ST STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03833-2456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-247-5442
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87 SCRIPPS DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-415-7010
Provider Business Practice Location Address Fax Number:
916-244-0100
Provider Enumeration Date:
10/21/2021

Additional Information

Authorized Official

Authorized Official Last Name:
IKEMIRE
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
916-500-8086

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: C159092 . This is a "MBC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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