Healthcare Provider Details

I. General information

NPI: 1295646057
Provider Name (Legal Business Name): PAYNE FAMILY & PSYCHIATRIC NURSING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 AUSTIN WAY
SANTA ROSA CA
95404-3608
US

IV. Provider business mailing address

1828 AUSTIN WAY
SANTA ROSA CA
95404-3608
US

V. Phone/Fax

Practice location:
  • Phone: 707-758-7362
  • Fax: 707-408-2083
Mailing address:
  • Phone: 707-758-7362
  • Fax: 707-408-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. LEMELM WOLDAY PAYNE
Title or Position: OWNER
Credential: FNPC PMHNP BC
Phone: 707-758-7362