| |
1500 Derby St Berkeley CA 94703-1817 | |
(510) 644-6360 | |
Not Available |
Full Name | |
---|---|
Speciality | Community/behavioral Health |
Location | 1500 Derby St, Berkeley, California |
Authorized Official Name and Position | Sandy Hobson (QUALITY ASSURANCE DIRECTOR) |
Authorized Official Contact | 5107255727 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2275 Arlington Dr San Leandro CA 94578-1132 Ph: (510) 654-4004 | 1500 Derby St Berkeley CA 94703-1817 Ph: (510) 644-6360 |
NPI Number | 1669752937 |
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Provider Enumeration Date | 08/18/2011 |
Last Update Date | 09/02/2020 |
Certification Date | 09/02/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669752937 | NPI | - | NPPES |
0015 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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