Provider Demographics
NPI: | 1619668498 |
---|---|
Name: | THE INDI WOMENS CLUB LLC |
Entity Type: | Organization |
Organization Name: | THE INDI WOMENS CLUB LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NIKKIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PATTERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | BSN, MCD |
Authorized Official - Phone: | 614-817-4160 |
Mailing Address - Street 1: | 5960 S LAND PARK DR # 1409 |
Mailing Address - Street 2: | |
Mailing Address - City: | SACRAMENTO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95822-3313 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 510-768-8433 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2825 CAPITOL AVE |
Practice Address - Street 2: | |
Practice Address - City: | SACRAMENTO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95816-6039 |
Practice Address - Country: | US |
Practice Address - Phone: | 510-768-8433 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-05-15 |
Last Update Date: | 2023-05-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 374J00000X | Nursing Service Related Providers | Doula | Group - Multi-Specialty | |
No | 171400000X | Other Service Providers | Health & Wellness Coach | Group - Multi-Specialty |