| |
840 Colusa Ave Berkeley CA 94707-1858 | |
(510) 644-6368 | |
Not Available |
Full Name | |
---|---|
Speciality | Community/behavioral Health |
Location | 840 Colusa Ave, Berkeley, California |
Authorized Official Name and Position | Katherine West (CHIEF OPERATIONS OFFICER) |
Authorized Official Contact | 5105200935 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2275 Arlington Dr San Leandro CA 94578-1132 Ph: (510) 654-4004 | 840 Colusa Ave Berkeley CA 94707-1858 Ph: (510) 644-6368 |
NPI Number | 1134507288 |
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Provider Enumeration Date | 05/09/2015 |
Last Update Date | 04/05/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134507288 | NPI | - | NPPES |
0015 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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