1992736086 NPI number — WINTERS HEALTHCARE FOUNDATION, INC.

Table of content: (NPI 1992736086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992736086 NPI number — WINTERS HEALTHCARE FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINTERS HEALTHCARE FOUNDATION, 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:
WINTERS HEALTHCARE CLINIC
Provider Other Organization Name Type Code:
5
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:
1992736086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 E GRANT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95694-1780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-795-4377
Provider Business Mailing Address Fax Number:
530-795-9541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 E GRANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95694-1780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-795-4377
Provider Business Practice Location Address Fax Number:
530-795-9541
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELSCH
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
530-795-4377

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 030000787 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HAP71037F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ04589Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2254671 . This is a "STATE CORPORATION NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BCP71037F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FHC71037F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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