| |
1 Bolivar Dr Berkeley CA 94710-2210 | |
(510) 649-1177 | |
(510) 649-0322 |
Full Name | |
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Speciality | Residential Treatment Facility, Emotionally Disturbed Children |
Location | 1 Bolivar Dr, Berkeley, California |
Authorized Official Name and Position | Michael James Thomas (SENIOR DIRECTOR) |
Authorized Official Contact | 5106491177 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1 Bolivar Dr Berkeley CA 94710-2210 Ph: (510) 649-1177 | 1 Bolivar Dr Berkeley CA 94710-2210 Ph: (510) 649-1177 |
NPI Number | 1912054701 |
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Provider Enumeration Date | 01/04/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912054701 | NPI | - | NPPES |
261QM0855X | Other | CA | ADOLESCENT, CHILD MS |
261QM0850X | Other | CA | ADULT MENTAL HEALTH |
322D00000X | Other | CA | RESIDENTIAL TREATMENT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | (California) | Primary |
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