Healthcare Provider Details

I. General information

NPI: 1043705908
Provider Name (Legal Business Name): VERDANT BEHAVIORAL HEALTH, A NURSING ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 06/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E CAMPBELL AVE # 201
CAMPBELL CA
95008-7700
US

IV. Provider business mailing address

125 E CAMPBELL AVE # 201
CAMPBELL CA
95008-7700
US

V. Phone/Fax

Practice location:
  • Phone: 408-508-6256
  • Fax: 408-608-0376
Mailing address:
  • Phone: 408-508-6256
  • Fax: 408-608-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ARNOLD FOSAH
Title or Position: FOUNDER, CEO
Credential: PMHNP - BC
Phone: 408-674-0310