Healthcare Provider Details

I. General information

NPI: 1104303841
Provider Name (Legal Business Name): ADVENT GROUP MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 BRYANT AVE
MOUNTAIN VIEW CA
94040-4580
US

IV. Provider business mailing address

90 GREAT OAKS BLVD
SAN JOSE CA
95119-1314
US

V. Phone/Fax

Practice location:
  • Phone: 408-281-0708
  • Fax: 408-281-2658
Mailing address:
  • Phone: 408-281-0708
  • Fax: 408-281-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FAITH LUCERO
Title or Position: BILLING ASSISTANT
Credential:
Phone: 408-256-4643