Healthcare Provider Details

I. General information

NPI: 1659038875
Provider Name (Legal Business Name): FAMILY BRIDGES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 14TH ST
OAKLAND CA
94612-4070
US

IV. Provider business mailing address

168 11TH ST
OAKLAND CA
94607-4841
US

V. Phone/Fax

Practice location:
  • Phone: 510-595-5588
  • Fax:
Mailing address:
  • Phone: 510-839-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: CORINNE JAN
Title or Position: CEO
Credential:
Phone: 510-839-2022