Healthcare Provider Details

I. General information

NPI: 1801088059
Provider Name (Legal Business Name): LINCOLN CHILD CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 FOOTHILL BLVD APT 9
OAKLAND CA
94601-3644
US

IV. Provider business mailing address

3524 FOOTHILL BLVD APT 9 3524 FOOTHILL BLVD APT 9
OAKLAND CA
94601-3644
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-3111
  • Fax:
Mailing address:
  • Phone: 510-531-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1Q1Y0800X
License Number StateCA

VIII. Authorized Official

Name: MR. BILAL K ZINDANI I
Title or Position: SHIFT LEADER
Credential: BA
Phone: 510-531-3111