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795 Fletcher Lane Hayward CA 94544-1008 | |
| (510) 247-8300 | |
| (510) 247-8295 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Methadone |
| Location | 795 Fletcher Lane, Hayward, California |
| Authorized Official Name and Position | Bruce Jarvie (VP, TREASURER) |
| Authorized Official Contact | 2143793300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1720 Lakepointe Dr Ste 117 Lewisville TX 75057-6425 Ph: (214) 379-3300 | 795 Fletcher Lane Hayward CA 94544-1008 Ph: (510) 247-8300 |
| NPI Number | 1952529711 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 07/29/2024 |
| Certification Date | 07/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952529711 | NPI | - | NPPES |
| 01-98 | Other | CA | OTP LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 01-93 (California) | Secondary |
| 261QM2800X | Clinic/center - Methadone | 01-98 (California) | Primary |
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