Healthcare Provider Details

I. General information

NPI: 1235915638
Provider Name (Legal Business Name): CSD EXPANSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 100
CONCORD CA
94520-4969
US

IV. Provider business mailing address

1200 CONCORD AVE STE 100
CONCORD CA
94520-4969
US

V. Phone/Fax

Practice location:
  • Phone: 877-910-6538
  • Fax: 510-373-1738
Mailing address:
  • Phone: 510-268-8120
  • Fax: 510-373-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY BOZARTH
Title or Position: CEO
Credential:
Phone: 510-268-8120