Provider Demographics
NPI:1396951430
Name:PETALUMA PEOPLE SERVICES CENTER
Entity type:Organization
Organization Name:PETALUMA PEOPLE SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELECE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-765-8488
Mailing Address - Street 1:1500 PETALUMA BLVD SOUTH
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952
Mailing Address - Country:US
Mailing Address - Phone:707-765-8488
Mailing Address - Fax:707-765-8482
Practice Address - Street 1:900 HOPPER STREET
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952
Practice Address - Country:US
Practice Address - Phone:707-776-4777
Practice Address - Fax:707-765-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91021154251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RU49C7Medicare UPIN