Provider Demographics
NPI:1689821423
Name:WAKEUP CALL, INC.
Entity Type:Organization
Organization Name:WAKEUP CALL, INC.
Other - Org Name:WAKEUP CALL INC. COMMUNITY INTEGRATION (WCCI)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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:916-596-5925
Practice Address - Fax:866-310-8868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKEUP CALL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-23
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336926251B00000X, 251S00000X
CA253Z00000X
CA1000162385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC2329546OtherCALIFORNIA SECRETARY OF STATE
CA1689821423Medicaid
CA1127620OtherCALIFORNIA DGS SMALL BUSINESS AND DVBE SERVICES