Healthcare Provider Details

I. General information

NPI: 1083320543
Provider Name (Legal Business Name): TRI-CITIES COMMUNITY DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37620 FILBERT ST
NEWARK CA
94560-3538
US

IV. Provider business mailing address

37620 FILBERT ST
NEWARK CA
94560-3538
US

V. Phone/Fax

Practice location:
  • Phone: 510-790-9092
  • Fax:
Mailing address:
  • Phone: 510-790-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: EDWARD WRIGHT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-386-5938