| |
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 B. Gates (CFO) |
Authorized Official Contact | 5104507357 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2000 Powell St 10th Floor Emeryville CA 94608-1804 Ph: (510) 450-7347 | 2001 Dwight Way Berkeley CA 94704-2608 Ph: (510) 204-4444 |
NPI Number | 1447604814 |
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Provider Enumeration Date | 04/21/2016 |
Last Update Date | 01/20/2022 |
Certification Date | 01/20/2022 |
Medicare PECOS PAC ID | 3476506528 |
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Medicare Enrollment ID | O20171215000451 |
Identifier | Type | State | Issuer |
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1447604814 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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