Provider Demographics
NPI:1336494012
Name:THE HAWTHORNE GROUP INC
Entity Type:Organization
Organization Name:THE HAWTHORNE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-470-8311
Mailing Address - Street 1:1010 CAMERADO DR STE 102B
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7984
Mailing Address - Country:US
Mailing Address - Phone:916-470-8311
Mailing Address - Fax:775-849-2321
Practice Address - Street 1:9190 DOUBLE DIAMOND PKWY STE 130
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4842
Practice Address - Country:US
Practice Address - Phone:916-470-8311
Practice Address - Fax:775-849-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20101208611251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4986NSP-4OtherNURSING POOL