| NPI | 1417167636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE ANN DACOSTA Program Supervisor 510-667-4901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CA LCS17287) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-08-22 |