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16160 Ashland Ave Room 30a San Lorenzo CA 94580-1116 | |
| (510) 317-5100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 16160 Ashland Ave, San Lorenzo, California |
| Authorized Official Name and Position | Scott Osborn (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 5105200943 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15942 Foothill Blvd San Leandro CA 94578-2102 Ph: (510) 317-1446 | 16160 Ashland Ave Room 30a San Lorenzo CA 94580-1116 Ph: (510) 317-5100 |
| NPI Number | 1811435225 |
|---|---|
| Provider Enumeration Date | 02/06/2017 |
| Last Update Date | 02/14/2023 |
| Certification Date | 02/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811435225 | NPI | - | NPPES |
| 0015 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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