OrganizationActive
Potential Way
NPI 1588434849 · Lodging Provider · Clearlake Oaks, CA
Provider details
- NPI number
- 1588434849
- Entity type
- Organization
- Primary specialty
- Lodging ProviderOther Service Providers
- Organization subpart
- No
- Authorized official
- Jacqueline Kelly, Ceo(916) 613-0098
Specialties & taxonomies
Other Service Providers
- Home Health Agency251E00000X
Agencies
- Meals Provider174200000X
Other Service Providers
- Case Management Agency251B00000X
Agencies
Practice location
12901 E Highway 20
Clearlake Oaks, CA 95423-9326
Phone: (916) 613-0098
Fax: (707) 703-5792
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 516
Clearlake Oaks, CA 95423-0516
Registry dates
- Enumerated
- 2024-01-08
- Last updated
- 2024-01-08
- Certified
- 2024-01-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.