Healthcare Provider Details

I. General information

NPI: 1194840868
Provider Name (Legal Business Name): ADVENT GROUP MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/21/2022
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 ARPEGGIO AVE SOUTH VALLEY HOME
SAN JOSE CA
95136-2307
US

IV. Provider business mailing address

90 GREAT OAKS BLVD 180
SAN JOSE CA
95119-1314
US

V. Phone/Fax

Practice location:
  • Phone: 408-226-2389
  • Fax:
Mailing address:
  • Phone: 408-281-0708
  • Fax: 408-281-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MARK MILLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 408-281-0708