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General NPI Number Information
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NPI Number | 1114807617
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Entity Type | Organization
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Legal Business Name | PRISON TRANSITION NETWORK
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 690 MARSHALL RD
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City | VACAVILLE
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State | CA
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Zip | 95687-5433
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Country | US
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Telephone | 707-637-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 690 MARSHALL RD
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City | VACAVILLE
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State | CA
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Zip | 95687-5433
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Country | US
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Telephone | 707-637-6581
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIM BEATY
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Credential |
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Telephone | 707-637-6582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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