| |
2001 Dwight Way Berkeley CA 94704-2608 | |
(510) 204-4444 | |
Not Available |
Full Name | |
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Speciality | Psychiatric Unit |
Location | 2001 Dwight Way, Berkeley, California |
Authorized Official Name and Position | John Gates (CFO SHBA) |
Authorized Official Contact | 5104507357 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 742920 Los Angeles CA 90074-2920 Ph: (855) 398-1633 | 2001 Dwight Way Berkeley CA 94704-2608 Ph: (510) 204-4444 |
NPI Number | 1922180827 |
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Provider Enumeration Date | 10/19/2006 |
Last Update Date | 04/21/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922180827 | NPI | - | NPPES |
ZZR000305F | Medicaid | CA | |
HSC00305F | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
273R00000X | Psychiatric Unit | 140000004 (California) | Primary |
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