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General NPI Number Information
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NPI Number | 1104968775
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Entity Type | Organization
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Legal Business Name | CONTRA COSTA HEALTH SERVICES
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 2523 EL PORTAL DR SUITE #103
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City | SAN PABLO
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State | CA
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Zip | 94806-3305
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Country | US
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Telephone | 510-374-7500
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Fax | 510-374-7504
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Provider Business Mailing Address
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Address Line | 2523 EL PORTAL DR SUITE #103
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City | SAN PABLO
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State | CA
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Zip | 94806-3305
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Country | US
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Telephone | 510-374-7398
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Fax | 510-374-7504
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Authorized Official
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Title or Position | CASE MANAGER
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Name | MR. ERIC DARNELL DEVERS
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Credential |
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Telephone | 510-374-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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