Healthcare Provider Details

I. General information

NPI: 1285929034
Provider Name (Legal Business Name): ALTERNATIVE FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 EXECUTIVE PARK BOULEVARD
SAN FRANCSICO CA
94134
US

IV. Provider business mailing address

1418 10TH AVE
SAN FRANCISCO CA
94122-3662
US

V. Phone/Fax

Practice location:
  • Phone: 415-656-0116
  • Fax:
Mailing address:
  • Phone: 415-656-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number19268
License Number StateCA

VIII. Authorized Official

Name: JAY BERKIN
Title or Position: DIRECTOR
Credential:
Phone: 415-656-0116