Healthcare Provider Details

I. General information

NPI: 1780476812
Provider Name (Legal Business Name): COMMUNITIES UNITED FOR RESTORATIVE YOUTH JUSTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 35TH AVE
OAKLAND CA
94601-3489
US

IV. Provider business mailing address

1150 35TH AVE
OAKLAND CA
94601-3489
US

V. Phone/Fax

Practice location:
  • Phone: 510-842-9365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE GALVIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-689-7350