1528327590 NPI number — CENTER FOR INDEPENDENT LIVING, 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 1528327590 NPI number — CENTER FOR INDEPENDENT LIVING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR INDEPENDENT LIVING, 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:
1528327590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3075 ADELINE ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94703-2579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-841-4776
Provider Business Mailing Address Fax Number:
510-841-6168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39350 GALLAUDET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94538-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-794-3666
Provider Business Practice Location Address Fax Number:
510-794-2409
Provider Enumeration Date:
05/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WRONG
Authorized Official First Name:
YOMI
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
510-841-4776

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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