1346519139 NPI number — CENTER FOR COMMUNITY HEALTH AND WELL-BEING, INC

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 1346519139 NPI number — CENTER FOR COMMUNITY HEALTH AND WELL-BEING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR COMMUNITY HEALTH AND WELL-BEING, 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:
6
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:
1346519139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 T STREET
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:
95814-6822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-897-9900
Provider Business Mailing Address Fax Number:
916-667-8791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-5406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-897-9900
Provider Business Practice Location Address Fax Number:
916-667-8791
Provider Enumeration Date:
12/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PETKO
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CEO/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
916-558-4800

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , 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)





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