Healthcare Provider Details

I. General information

NPI: 1821118456
Provider Name (Legal Business Name): JAMES N. HARDWICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 HIGH ST
AUBURN CA
95603-5015
US

IV. Provider business mailing address

4673 THORNTON AVE SUITE A
FREMONT CA
94536-5663
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-9195
  • Fax: 530-889-9197
Mailing address:
  • Phone: 510-791-8006
  • Fax: 510-791-0939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number310007AP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number310007BP
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number310007CP
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES NOLAN HARDWICK
Title or Position: OWNER EXECUTIVE DIRECTOR
Credential:
Phone: 510-791-9048