1336494012 NPI number — THE HAWTHORNE GROUP INC

Table of content: (NPI 1336494012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336494012 NPI number — THE HAWTHORNE GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HAWTHORNE GROUP 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:
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:
1336494012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 CAMERADO DR STE 102B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMERON PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95682-7984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-470-8311
Provider Business Mailing Address Fax Number:
775-849-2321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9190 DOUBLE DIAMOND PKWY STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89521-4842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-470-8311
Provider Business Practice Location Address Fax Number:
775-849-2321
Provider Enumeration Date:
07/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHARLTON
Authorized Official First Name:
KIESHA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
916-470-8311

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  20101208611 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4986NSP-4 . This is a "NURSING POOL" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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