Healthcare Provider Details

I. General information

NPI: 1235647462
Provider Name (Legal Business Name): PEPPERMINT PALM SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10017 FEDERALIST LN
SACRAMENTO CA
95827-1934
US

IV. Provider business mailing address

10017 FEDERALIST LN
SACRAMENTO CA
95827-1934
US

V. Phone/Fax

Practice location:
  • Phone: 888-471-7469
  • Fax: 888-471-7469
Mailing address:
  • Phone: 888-471-7469
  • Fax: 888-471-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFEAR NELSON WRIGHT
Title or Position: CEO
Credential:
Phone: 888-471-7469