Provider Demographics
NPI:1235647462
Name:PEPPERMINT PALM SENIOR CARE
Entity Type:Organization
Organization Name:PEPPERMINT PALM SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFEAR
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-471-7469
Mailing Address - Street 1:10017 FEDERALIST LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1934
Mailing Address - Country:US
Mailing Address - Phone:888-471-7469
Mailing Address - Fax:888-471-7469
Practice Address - Street 1:10017 FEDERALIST LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1934
Practice Address - Country:US
Practice Address - Phone:888-471-7469
Practice Address - Fax:888-471-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No347C00000XTransportation ServicesPrivate Vehicle