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General NPI Number Information
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NPI Number | 1336494012
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Entity Type | Organization
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Legal Business Name | THE HAWTHORNE GROUP INC
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 9190 DOUBLE DIAMOND PKWY STE 130
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City | RENO
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State | NV
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Zip | 89521-4842
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Country | US
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Telephone | 916-470-8311
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Fax | 775-849-2321
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Provider Business Mailing Address
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Address Line | 1010 CAMERADO DR STE 102B
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City | CAMERON PARK
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State | CA
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Zip | 95682-7984
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Country | US
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Telephone | 916-470-8311
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Fax | 775-849-2321
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MS. KIESHA CHARLTON
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Credential |
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Telephone | 916-470-8311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 20101208611
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License Number State | NV
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