Healthcare Provider Details

I. General information

NPI: 1205138765
Provider Name (Legal Business Name): THE VILLAGE PROJECT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 SOTO ST
SEASIDE CA
93955-3942
US

IV. Provider business mailing address

1069 BROADWAY AVE
SEASIDE CA
93955-4996
US

V. Phone/Fax

Practice location:
  • Phone: 831-601-3810
  • Fax:
Mailing address:
  • Phone: 831-392-1500
  • Fax: 831-392-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number302R00000X
License Number StateCA

VIII. Authorized Official

Name: MR. MEL MASON
Title or Position: DIRECTOR
Credential: LCSW
Phone: 831-392-1500