Provider Demographics
NPI:1366951246
Name:MAGENTA HAZE PUBLIC RELATIONS
Entity type:Organization
Organization Name:MAGENTA HAZE PUBLIC RELATIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELYNG
Authorized Official - Middle Name:KNICOLE
Authorized Official - Last Name:MCCOVERY
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:925-217-4833
Mailing Address - Street 1:1500 GOLDENBAY AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5863
Mailing Address - Country:US
Mailing Address - Phone:925-217-4833
Mailing Address - Fax:
Practice Address - Street 1:323 E VERNALIS RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-9376
Practice Address - Country:US
Practice Address - Phone:510-372-5830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-23
Last Update Date:2017-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No315D00000XNursing & Custodial Care FacilitiesHospice, InpatientGroup - Multi-Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty