Healthcare Provider Details

I. General information

NPI: 1003189614
Provider Name (Legal Business Name): INTERIM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 PEARL ST INTERIM INC
MONTEREY CA
93940-3070
US

IV. Provider business mailing address

412 DELA VINA AVE APT 30
MONTEREY CA
93940-3962
US

V. Phone/Fax

Practice location:
  • Phone: 816-649-4522
  • Fax:
Mailing address:
  • Phone: 660-562-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN GAST
Title or Position: WELLNESS RECOVERY COORDINATOR
Credential:
Phone: 660-562-7800