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NPI Code Detail

MEDICARE: CORDILLERAS MENTAL HEALTH CORPORATION

MEDICARE: CORDILLERAS MENTAL HEALTH CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment FacilityDMH 02 68 015CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063509123
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORDILLERAS MENTAL HEALTH CORPORATION
Provider Business Mailing Address
First Line : 1080 MARINA VILLAGE PARKWAY
Second Line : SUITE 100
City : ALAMEDA
State : CA
Zip : 94501-1078
Country : US
Telephone Number : 510-337-7950
Fax Number : 510-337-7969
Provider Business Practice Location Address
First Line : 200 EDMONDS RD
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94062-3813
Country : US
Telephone Number : 650-367-1890
Fax Number : 650-369-6465
Authorized Official
Title or Position : PROVIDER RELATIONS SUPERVISOR
Name : LORENA LOPEZ
Credential :
Telephone Number : 510-337-7950
Provider Enumeration Date : 10/09/2006
Last Update Date : 03/31/2023

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Directions to “CORDILLERAS MENTAL HEALTH CORPORATION ” Practice Location

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