Provider Demographics
NPI:1568210334
Name:BRAIN HEAVEN WITH ADONAI A NURSING CORPORATION
Entity type:Organization
Organization Name:BRAIN HEAVEN WITH ADONAI A NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-MSN
Authorized Official - Phone:209-470-6692
Mailing Address - Street 1:17875 VON KARMAN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6212
Mailing Address - Country:US
Mailing Address - Phone:949-694-9449
Mailing Address - Fax:
Practice Address - Street 1:17875 VON KARMAN AVE STE 150
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6212
Practice Address - Country:US
Practice Address - Phone:949-694-9449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty