Healthcare Provider Details

I. General information

NPI: 1881931681
Provider Name (Legal Business Name): UJIMA CENTRAL MOTHERS' PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CHURCH LN
SAN PABLO CA
94806-3707
US

IV. Provider business mailing address

2975 TREAT BLVD STE B5
CONCORD CA
94518-3687
US

V. Phone/Fax

Practice location:
  • Phone: 510-236-3139
  • Fax: 510-236-3200
Mailing address:
  • Phone: 925-691-5083
  • Fax: 925-691-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. RITA B. SCHANK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-236-3139