1225041668 NPI number — WAKEUP CALL, INC

Table of content: (NPI 1225041668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225041668 NPI number — WAKEUP CALL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAKEUP CALL, 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:
YOUTH SAFE HAVEN
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:
1225041668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 293744
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95829-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-596-5928
Provider Business Mailing Address Fax Number:
866-310-8868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3602 26TH AVE
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:
95820-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-596-5928
Provider Business Practice Location Address Fax Number:
866-310-8868
Provider Enumeration Date:
08/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NKWOPARA
Authorized Official First Name:
THEO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
916-475-2557

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1000162 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251V00000X , with the licence number: 1000162 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1127620 . This is a "CALIFORNIA DGS-SMALL BUSINESS AND DVBE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: C2329546 . This is a "CALIFORNIA SECRETARY OF STATE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000162 . This is a "SACRAMENTO COUNTY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".