Provider Demographics
NPI:1326854514
Name:KNO'QOTI NATIVE WELLNESS, INC.
Entity type:Organization
Organization Name:KNO'QOTI NATIVE WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-900-2121
Mailing Address - Street 1:809 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5510
Mailing Address - Country:US
Mailing Address - Phone:707-900-2121
Mailing Address - Fax:
Practice Address - Street 1:809 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5510
Practice Address - Country:US
Practice Address - Phone:707-900-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
No332U00000XSuppliersHome Delivered Meals
No385H00000XRespite Care FacilityRespite Care