Healthcare Provider Details

I. General information

NPI: 1396936605
Provider Name (Legal Business Name): THE RESOURCE ENVIRONMENT FOR UNDERPRIVILEGED GROUPS ENTERPRISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 TOMPKINS AVE
OAKLAND CA
94619-2820
US

IV. Provider business mailing address

PO BOX 19275
OAKLAND CA
94619-0275
US

V. Phone/Fax

Practice location:
  • Phone: 510-301-5809
  • Fax:
Mailing address:
  • Phone: 510-301-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number015600744
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number015600412
License Number StateCA

VIII. Authorized Official

Name: MR. JASON B HENDERSON
Title or Position: EXCEUTIVE DIRECTOR
Credential:
Phone: 510-301-5809