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General NPI Number Information
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NPI Number | 1740051309
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Entity Type | Organization
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Legal Business Name | LA FAMILIA SANA
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 233 N CLOVERDALE BLVD
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City | CLOVERDALE
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State | CA
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Zip | 95425
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Country | US
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Telephone | 770-669-0289
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | CLOVERDALE
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State | CA
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Zip | 95425
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Country | US
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Telephone | 707-669-0289
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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 | MS. JADE ESTHER WEYMOUTH
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Credential | MA
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Telephone | 707-669-0289
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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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