Healthcare Provider Details

I. General information

NPI: 1932343951
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: 04/21/2009
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 LOMA VISTA AVE
OAKLAND CA
94619-1426
US

IV. Provider business mailing address

3906 LOMA VISTA AVE
OAKLAND CA
94619-1426
US

V. Phone/Fax

Practice location:
  • Phone: 510-530-8541
  • Fax:
Mailing address:
  • Phone: 510-530-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number015650058
License Number StateCA

VIII. Authorized Official

Name: JASON HENDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-301-5809