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General NPI Number Information
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NPI Number | 1104151059
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Entity Type | Organization
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Legal Business Name | EMQ FAMILIES FIRST
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Dates
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Enumeration Date | 10/10/2009
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Last Update Date | 10/10/2009
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Provider Practice Location Address
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Address Line | 6630 MARYMONTE CT
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City | SAN JOSE
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State | CA
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Zip | 95120-4517
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Country | US
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Telephone | 408-205-8996
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Fax |
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Provider Business Mailing Address
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Address Line | 6630 MARYMONTE CT
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City | SAN JOSE
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State | CA
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Zip | 95120-4517
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Country | US
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Telephone | 408-205-8996
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | ROBERT DEHN
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Credential |
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Telephone | 408-335-1931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 3649
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License Number State | CA
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