Provider Demographics
NPI:1982649430
Name:THE CENTER FOR COMMUNITY HEALTH & WELL BEING INC
Entity Type:Organization
Organization Name:THE CENTER FOR COMMUNITY HEALTH & WELL BEING INC
Other - Org Name:THE BIRTHING PROJECT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-558-4820
Mailing Address - Street 1:1900 T ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6822
Mailing Address - Country:US
Mailing Address - Phone:916-558-4820
Mailing Address - Fax:916-558-4806
Practice Address - Street 1:1900 T ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6822
Practice Address - Country:US
Practice Address - Phone:916-558-4820
Practice Address - Fax:916-558-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD30000463261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70503FMedicaid