Healthcare Provider Details

I. General information

NPI: 1164336756
Provider Name (Legal Business Name): PLUM ENTERPRISE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 DONEGAL DR
VALLEJO CA
94589-1855
US

IV. Provider business mailing address

310 DONEGAL DR
VALLEJO CA
94589-1855
US

V. Phone/Fax

Practice location:
  • Phone: 707-590-4760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHONTELL BEASLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 707-590-4760