Healthcare Provider Details

I. General information

NPI: 1639517097
Provider Name (Legal Business Name): SUBACUTE TREATMENT FOR ADOLESCENT REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 08/14/2026
Certification Date: 09/29/2025
Deactivation Date: 09/30/2025
Reactivation Date: 08/14/2026

III. Provider practice location address

1570 WARD ST
HAYWARD CA
94541-3030
US

IV. Provider business mailing address

400 ESTUDILLO AVE STE 100
SAN LEANDRO CA
94577-4962
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-9200
  • Fax:
Mailing address:
  • Phone: 510-352-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: KENT DUNLAP
Title or Position: PRESIDENT AND CHIEF EXECUTIVE OFFIC
Credential:
Phone: 310-221-6336