1992134092 NPI number — PORTIA BELL HUME BEHAVIORAL HEALTH AND TRIANING CENTER

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 1992134092 NPI number — PORTIA BELL HUME BEHAVIORAL HEALTH AND TRIANING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTIA BELL HUME BEHAVIORAL HEALTH AND TRIANING 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:
1992134092
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:
925-825-8179
Provider Business Mailing Address Fax Number:
925-825-7094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8151 VILLAGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94568-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-223-8047
Provider Business Practice Location Address Fax Number:
925-223-8048
Provider Enumeration Date:
11/08/2013

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:  14000460 , 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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