Provider Demographics
NPI:1154195196
Name:ROSEVILLE HEALTH & WELLNESS CENTER
Entity type:Organization
Organization Name:ROSEVILLE HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DERAPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-677-1210
Mailing Address - Street 1:1650 LEAD HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3061
Mailing Address - Country:US
Mailing Address - Phone:916-677-1200
Mailing Address - Fax:916-677-1204
Practice Address - Street 1:1650 LEAD HILL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3061
Practice Address - Country:US
Practice Address - Phone:916-677-1200
Practice Address - Fax:916-677-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty