1275989188 NPI number — PORTIA BELL HUME BEHAVIORAL HEALTH & TRAINING CENTER

Table of content: (NPI 1275989188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275989188 NPI number — PORTIA BELL HUME BEHAVIORAL HEALTH & TRAINING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTIA BELL HUME BEHAVIORAL HEALTH & TRAINING CENTER
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:
6
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:
1275989188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 WILLOW PASS RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94520-7930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-825-1793
Provider Business Mailing Address Fax Number:
925-825-9094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3095 RICHMOND PKWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-825-1793
Provider Business Practice Location Address Fax Number:
925-825-7094
Provider Enumeration Date:
05/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SIKAND
Authorized Official First Name:
JOTY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-825-1793

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  14000462 , 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: 8187 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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