1821163767 NPI number — NEW COVENANT CARE OF CALIFORNIA, INC.

Table of content: ADRIAN MARIE KRUTZ FNP (NPI 1245674498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821163767 NPI number — NEW COVENANT CARE OF CALIFORNIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW COVENANT CARE OF CALIFORNIA, 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:
1821163767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 TAMPICO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-933-7970
Provider Business Mailing Address Fax Number:
925-256-1676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 TAMPICO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-933-7970
Provider Business Practice Location Address Fax Number:
925-256-1676
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KREH
Authorized Official First Name:
LAWRENCE (LARRY)
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF OPERATIONS
Authorized Official Telephone Number:
925-937-7400

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  140000138 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZR06213H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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