1013249986 NPI number — EARLE BAUM CENTER OF THE BLIND INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013249986 NPI number — EARLE BAUM CENTER OF THE BLIND INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EARLE BAUM CENTER OF THE BLIND INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013249986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4539 OCCIDENTAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95401-5635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-523-3222
Provider Business Mailing Address Fax Number:
707-636-2768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4539 OCCIDENTAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95401-5635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-523-3222
Provider Business Practice Location Address Fax Number:
707-636-2768
Provider Enumeration Date:
02/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BRENNER
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
707-523-3222

Provider Taxonomy Codes

  • Taxonomy code: 152WL0500X , with the licence number:  8817T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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