Healthcare Provider Details

I. General information

NPI: 1598412041
Provider Name (Legal Business Name): URBAN TILTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 BROOKSIDE DR
RICHMOND CA
94801-1301
US

IV. Provider business mailing address

323 BROOKSIDE DR
RICHMOND CA
94801-1301
US

V. Phone/Fax

Practice location:
  • Phone: 510-232-0911
  • Fax:
Mailing address:
  • Phone: 510-232-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCO LEMUS
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 510-932-1059