Healthcare Provider Details

I. General information

NPI: 1346519139
Provider Name (Legal Business Name): CENTER FOR COMMUNITY HEALTH AND WELL-BEING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 HOSPITAL DRIVE SUITE I
SACRAMENTO CA
95823-5406
US

IV. Provider business mailing address

1900 T STREET
SACRAMENTO CA
95814-6822
US

V. Phone/Fax

Practice location:
  • Phone: 916-897-9900
  • Fax: 916-667-8791
Mailing address:
  • Phone: 916-897-9900
  • Fax: 916-667-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: WENDY J. PETKO
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential:
Phone: 916-558-4800