Healthcare Provider Details

I. General information

NPI: 1649054461
Provider Name (Legal Business Name): PLAYWELL COLLECTIVE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 10/20/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10886 BERNADINE AVE
CLOVIS CA
93619-5223
US

IV. Provider business mailing address

10886 BERNADINE AVE
CLOVIS CA
93619-5223
US

V. Phone/Fax

Practice location:
  • Phone: 559-392-8860
  • Fax:
Mailing address:
  • Phone: 559-392-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANA SCHMALZEL
Title or Position: OCCUPATIONAL THERAPIST, CFO
Credential: MS, OTR/L
Phone: 559-492-9493