Provider Demographics
NPI:1225041668
Name:WAKEUP CALL, INC
Entity Type:Organization
Organization Name:WAKEUP CALL, INC
Other - Org Name:YOUTH SAFE HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THEO
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWOPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-475-2557
Mailing Address - Street 1:PO BOX 293744
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-3744
Mailing Address - Country:US
Mailing Address - Phone:916-596-5928
Mailing Address - Fax:866-310-8868
Practice Address - Street 1:3602 26TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4804
Practice Address - Country:US
Practice Address - Phone:916-596-5928
Practice Address - Fax:866-310-8868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKEUP CALL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-15
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000162251S00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1127620OtherCALIFORNIA DGS-SMALL BUSINESS AND DVBE SERVICES
CAC2329546OtherCALIFORNIA SECRETARY OF STATE
CA1000162OtherSACRAMENTO COUNTY