1194904276 NPI number — ASIAN COMMUNITY MENTAL HEALTH BOARD

Table of content: (NPI 1194904276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194904276 NPI number — ASIAN COMMUNITY MENTAL HEALTH BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASIAN COMMUNITY MENTAL HEALTH BOARD
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:
ASIAN COMMUNITY MENTAL HEALTH 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:
1194904276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/02/2014
NPI Reactivation Date:
09/24/2014

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 8TH STREET
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94607-6527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-869-6000
Provider Business Mailing Address Fax Number:
510-839-4723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12240 SAN PABLO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94805-2453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-869-6000
Provider Business Practice Location Address Fax Number:
510-839-4723
Provider Enumeration Date:
10/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WONG
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM MANAGER
Authorized Official Telephone Number:
510-869-6087

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  079200069 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com