Provider Demographics
NPI:1912699802
Name:LIFETREAT NURSING CORPORATION
Entity Type:Organization
Organization Name:LIFETREAT NURSING CORPORATION
Other - Org Name:LIFETREAT URGENTCARE AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAITA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:205-218-6256
Mailing Address - Street 1:1341 HISTORICAL PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5064
Mailing Address - Country:US
Mailing Address - Phone:209-665-4151
Mailing Address - Fax:209-665-4452
Practice Address - Street 1:1341 HISTORICAL PLAZA WAY
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5064
Practice Address - Country:US
Practice Address - Phone:209-665-4151
Practice Address - Fax:209-665-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty