Healthcare Provider Details

I. General information

NPI: 1578212734
Provider Name (Legal Business Name): VERDANT BEHAVIORAL HEALTH, A NURSING ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MONTEREY ST
GILROY CA
95020-5826
US

IV. Provider business mailing address

7500 MONTEREY ST
GILROY CA
95020-5826
US

V. Phone/Fax

Practice location:
  • Phone: 408-674-0310
  • Fax:
Mailing address:
  • Phone: 408-674-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ARNOLD FOSAH
Title or Position: FOUNDER
Credential: PMHNP
Phone: 408-674-0310