MEDICARE: THE RESOURCE ENVIRONMENT FOR UNDERPRIVILEGED GROUPS ENTERPRISE, INC.

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
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1083541783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RESOURCE ENVIRONMENT FOR UNDERPRIVILEGED GROUPS ENTERPRISE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 19275
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-0275
Country	:	US
Telephone Number	:	510-301-5809
Fax Number	:

Provider Business Practice Location Address
First Line	:	8593 SUNSET AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-5316
Country	:	US
Telephone Number	:	510-301-5809
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JASON HENDERSON
Credential	:
Telephone Number	:	510-301-5809

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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