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General NPI Number Information
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NPI Number | 1194262881
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Entity Type | Organization
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Legal Business Name | SAVING GRACE COMMUNITY CENTER OF THE EAST BAY
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 81 JACKSON ST
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City | HAYWARD
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State | CA
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Zip | 94544-1905
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Country | US
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Telephone | 510-258-8869
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Fax |
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Provider Business Mailing Address
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Address Line | 81 JACKSON ST
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City | HAYWARD
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State | CA
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Zip | 94544-1905
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Country | US
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Telephone | 510-258-8869
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JACQUELINE ALICE SMITH
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Credential | LMFT
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Telephone | 510-258-8869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC# 48253
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License Number State | CA
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