POTENTIAL WAY NPI 1588434849

NPI Information

  • NPI: 1588434849
  • Provider Name: POTENTIAL WAY
  • Classification: Lodging - 177F00000X
  • Entity Type: Organization
  • Address: 12901 E HIGHWAY 20
    CLEARLAKE OAKS, CA
    ZIP 95423
  • Phone: (916) 613-0098

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NPI Details

POTENTIAL WAY is a lodging in Clearlake Oaks, CA. The provider is a public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home. POTENTIAL WAY NPI is 1588434849. The provider is registered as an organization entity type.

The provider's business location address is:

12901 E HIGHWAY 20
CLEARLAKE OAKS, CA
ZIP 95423-326
Phone: (916) 613-0098
Fax: (707) 703-5792

The provider's authorized official is Jacqueline Marie Kelly .
The authorized official title is Ceo and has the following contact phone number (916) 613-0098.

The enumeration date for this NPI number is 1/8/2024 and was last updated on 1/8/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1251E00000XHome HealthNo
2174200000XMealsNo
3251B00000XCase ManagementNo
4177F00000XLodgingYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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