Healthcare Provider Details

I. General information

NPI: 1376702290
Provider Name (Legal Business Name): INTERIM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CAMINO EL ESTERO
MONTEREY CA
93940-3231
US

IV. Provider business mailing address

5728 LORA CT
ATWATER CA
95301-8473
US

V. Phone/Fax

Practice location:
  • Phone: 831-758-9457
  • Fax:
Mailing address:
  • Phone:
  • 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: DANA WESTON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 831-758-9457