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General NPI Number Information
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NPI Number | 1811688302
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Entity Type | Organization
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Legal Business Name | YMCA OF SUPERIOR CALIFORNIA
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 2021 W ST
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City | SACRAMENTO
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State | CA
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Zip | 95818-1625
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Country | US
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Telephone | 916-452-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 1926 V ST
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City | SACRAMENTO
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State | CA
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Zip | 95818-1624
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Country | US
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Telephone | 916-529-9886
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF DEVELOPMENT
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Name | MS. NANCY L SMITH-FAGAN
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Credential |
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Telephone | 916-231-0362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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