Provider Demographics
NPI:1629630314
Name:ARCHWAY HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:ARCHWAY HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-405-9888
Mailing Address - Street 1:8950 CAL CENTER DR STE 112
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3236
Mailing Address - Country:US
Mailing Address - Phone:209-405-9888
Mailing Address - Fax:916-376-7467
Practice Address - Street 1:8950 CAL CENTER DR STE 112
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3236
Practice Address - Country:US
Practice Address - Phone:209-405-9888
Practice Address - Fax:916-376-7467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty