| NPI | 1124468145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN R WILSON Executive/Clinical Director/CEO 510-334-0003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CA 24677) |
| Additional Taxonomies | 251B00000X Case Management (Licence: CA LCS 24677) |
| 252Y00000X Early Intervention Provider Agency (Licence: CA LCS 24677) | |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2017-05-12 |