1073643680 NPI number — SENECA FAMILY OF AGENCIES

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 1073643680 NPI number — SENECA FAMILY OF AGENCIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENECA FAMILY OF AGENCIES
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:
CCC COMMUNITY BASED SERVICES
Provider Other Organization Name Type Code:
3
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:
1073643680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/09/2023
NPI Reactivation Date:
05/11/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8945 GOLF LINKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94605-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-317-1444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 CLAYTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94519-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-317-1444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSBORN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
510-520-0943

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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)

  • Identifier: 0015 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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