Healthcare Provider Details

I. General information

NPI: 1710779574
Provider Name (Legal Business Name): PEACEMAKERS' ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 CARTER ST
VALLEJO CA
94590-3105
US

IV. Provider business mailing address

421 CARTER ST
VALLEJO CA
94590-3105
US

V. Phone/Fax

Practice location:
  • Phone: 650-400-7660
  • Fax:
Mailing address:
  • Phone: 650-400-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD COCKRELL
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 650-400-7660