1285083113 NPI number — FRED FINCH YOUTH CENTER

Table of content: (NPI 1285083113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285083113 NPI number — FRED FINCH YOUTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRED FINCH YOUTH 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:
FRED FINCH YOUTH CENTER-YGNACIO VALLEY HIGH SCHOOL
Provider Other Organization Name Type Code:
5
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:
1285083113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 COOLIDGE AVE
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:
94602-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-482-2244
Provider Business Mailing Address Fax Number:
510-488-1960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 OAK GROVE 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:
94518-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-685-8414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
510-485-5214

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; 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)