Healthcare Provider Details

I. General information

NPI: 1215287933
Provider Name (Legal Business Name): PREPARING PEOPLE FOR SUCCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 SPORTS DR
SACRAMENTO CA
95834-1943
US

IV. Provider business mailing address

1513 SPORTS DR
SACRAMENTO CA
95834-1943
US

V. Phone/Fax

Practice location:
  • Phone: 916-289-4730
  • Fax:
Mailing address:
  • Phone: 916-289-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. SHAWN FREDERICKA VAUGHAN-WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential: CADC II
Phone: 916-289-4730