MEDICARE: BERKELEY ADDICTION TREATMENT SERIVCES

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	261QM2800X	Methadone Clinic	0190	CA

General Provider Information

NPI Number	:	1598956757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERKELEY ADDICTION TREATMENT SERIVCES

Provider Business Mailing Address
First Line	:	2975 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2975 SACRAMENTO ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2534
Country	:	US
Telephone Number	:	510-644-0200
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. MATONIA L WILLIAMS
Credential	:	MBA
Telephone Number	:	510-644-0200

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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