=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215287933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREPARING PEOPLE FOR SUCCESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2012
-----------------------------------------------------
Last Update Date | 09/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1513 SPORTS DR
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95834-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-289-4730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1513 SPORTS DR
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95834-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-289-4730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. SHAWN FREDERICKA VAUGHAN-WILLIAMS
-----------------------------------------------------
Credential | CADC II
-----------------------------------------------------
Telephone | 916-289-4730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------