Provider Demographics
NPI:1962587964
Name:NORTHERN CALIFORNIA CENTER FOR WELL-BEING
Entity type:Organization
Organization Name:NORTHERN CALIFORNIA CENTER FOR WELL-BEING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-387-5612
Mailing Address - Street 1:PO BOX 3644
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-3644
Mailing Address - Country:US
Mailing Address - Phone:707-575-6043
Mailing Address - Fax:707-575-1060
Practice Address - Street 1:500 DOYLE PARK DR STE 304A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-575-6043
Practice Address - Fax:707-575-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22825ZMedicare ID - Type Unspecified