Healthcare Provider Details

I. General information

NPI: 1912699802
Provider Name (Legal Business Name): LIFETREAT NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W ACACIA ST STE 2
STOCKTON CA
95203-2441
US

IV. Provider business mailing address

420 W ACACIA ST STE 2
STOCKTON CA
95203-2441
US

V. Phone/Fax

Practice location:
  • Phone: 209-665-4151
  • Fax: 209-665-4452
Mailing address:
  • Phone: 209-665-4151
  • Fax: 209-665-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IRENE W GAITA
Title or Position: FNP APRN-BC
Credential: APRN-BC
Phone: 205-218-6256