NPIMap

Organization Active NPI

Peebles Family Care Home

  • Durable Medical Equipment & Medical Supplies
  • Stockton, CA
National Provider Identifier
1861726432
Registry record updated Sep 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
WHL156309 Issued in CA
Legal business name
PEEBLES FAMILY CARE HOME
Practice address
404 North Broadway Ave
Stockton, CA 95205-4737
Phone
(209) 298-0840
Fax
(209) 944-5659
NPI assigned
Sep 29, 2009
Organization subpart
Yes
Parent organization
PALS ASSISTED LIVING SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Nawana Miesa Gray, CEO
Title
Administrator/Ceo
Phone
(209) 298-0849

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X WHL156309 CA Primary

Addresses

Primary practice location

404 North Broadway Ave
Stockton, CA 95205-4737

Mailing address

404 North Broadway Ave
Stockton, CA 95205-4737
Phone (209) 298-0840

Other names 1

  • PALS Assisted Living Services Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peebles Family Care Home4 organizations share this tax ID, including this one
Part of
Peebles Family Care Home

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254182400000",
    "number": "1861726432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 NORTH BROADWAY AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952054737",
            "telephone_number": "209-298-0840",
            "fax_number": "209-944-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 NORTH BROADWAY AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952054737",
            "telephone_number": "209-298-0840",
            "fax_number": "209-944-5659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEEBLES FAMILY CARE HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALS ASSISTED LIVING SERVICES INC",
        "enumeration_date": "2009-09-29",
        "last_updated": "2009-09-29",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "NAWANA",
        "authorized_official_middle_name": "MIESA",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "209-298-0849",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "WHL156309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PALS Assisted Living Services Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.