=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154553741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSES & PROFESSIONAL HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2009
-----------------------------------------------------
Last Update Date | 08/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2639 FOREST AVE SUTIE 110
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95928-4393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-899-2255
-----------------------------------------------------
Fax | 530-899-2260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2639 FOREST AVE SUTIE 110
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95928-4393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-899-2255
-----------------------------------------------------
Fax | 530-899-2260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF NURSE
-----------------------------------------------------
Name | MS. ROBERTA JENE LYNCH
-----------------------------------------------------
Credential | LVN
-----------------------------------------------------
Telephone | 530-519-1251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310500000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Intermediate Care Facility
-----------------------------------------------------
License Number | VN46854
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------