Provider Demographics
NPI:1417768144
Name:OUR COMMUNITY, OUR SENIORS
Entity type:Organization
Organization Name:OUR COMMUNITY, OUR SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHW COORDINATOR, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:MONAE
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-701-1557
Mailing Address - Street 1:14624B LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-8490
Mailing Address - Country:US
Mailing Address - Phone:707-701-1557
Mailing Address - Fax:
Practice Address - Street 1:14624B LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8490
Practice Address - Country:US
Practice Address - Phone:707-701-1557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty