Healthcare Provider Details

I. General information

NPI: 1508587296
Provider Name (Legal Business Name): CASSIDY KENSINGTON PAIGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

IV. Provider business mailing address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5100
  • Fax:
Mailing address:
  • Phone: 916-609-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: