| Masonic Homes Of California | |
|
34400 Mission Blvd Union City CA 94587-3604 | |
| (510) 471-3434 | |
| (510) 476-6329 |
| Full Name | Masonic Homes Of California |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 34400 Mission Blvd, Union City, California |
| Authorized Official Name and Position | Kimberly Rich (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8774886293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Masonic Homes Of California 34400 Mission Blvd Union City CA 94587-3604 Ph: (510) 471-3434 | Masonic Homes Of California 34400 Mission Blvd Union City CA 94587-3604 Ph: (510) 471-3434 |
| NPI Number | 1114111317 |
|---|---|
| Provider Enumeration Date | 08/30/2007 |
| Last Update Date | 11/22/2019 |
| Medicare PECOS PAC ID | 4183625361 |
|---|---|
| Medicare Enrollment ID | O20200709000957 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114111317 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Craig F Conner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831234640 PECOS PAC ID: 5395970891 Enrollment ID: I20131107001641 |
| Provider Name | Sheening Lin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174602726 PECOS PAC ID: 1557678364 Enrollment ID: I20150910002483 |
| Provider Name | David J Quinteros |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457669384 PECOS PAC ID: 9032499785 Enrollment ID: I20161215000400 |
| Provider Name | Lisa M. Goodwin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457490617 PECOS PAC ID: 6608289483 Enrollment ID: I20210115002399 |
| Provider Name | Ethan Ornstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316354434 PECOS PAC ID: 6608284716 Enrollment ID: I20210408002579 |
| Provider Name | Steven Alexander Mclaughlin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609996941 PECOS PAC ID: 6507265782 Enrollment ID: I20210519002495 |
| Provider Name | Elba Flores |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801102942 PECOS PAC ID: 2860843661 Enrollment ID: I20240105001801 |
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