Provider Demographics
NPI:1821232752
Name:WAKEUP CALL, INC.
Entity Type:Organization
Organization Name:WAKEUP CALL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:THEO
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWOPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-596-5928
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:
Mailing Address - Fax:
Practice Address - Street 1:5325 ENGLE RD
Practice Address - Street 2:SUITE 835
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3091
Practice Address - Country:US
Practice Address - Phone:916-569-5928
Practice Address - Fax:866-310-8868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAKEUP CALL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA924251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689821423OtherMEDI-CAL
CA341560OtherCOUNTY OF SACRAMENTO BUSINESS LICENSE
CA924OtherDEPARTMENT OF REHABILITATION/ FACILITY CERTIFICATION