Healthcare Provider Details

I. General information

NPI: 1114686631
Provider Name (Legal Business Name): IN SOMNO SECURITAS A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BUTTE ST
REDDING CA
96001-0827
US

IV. Provider business mailing address

1314 22ND AVE UNIT 22070
SAN FRANCISCO CA
94122-1650
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-2500
  • Fax:
Mailing address:
  • Phone: 415-290-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH DEWEY CHILDERS JR.
Title or Position: OWNER/PRESIDENT
Credential: CRNA
Phone: 415-290-1884