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General NPI Number Information
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NPI Number | 1225327786
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Entity Type | Organization
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Legal Business Name | ST VINCENTS
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 1 SAINT VINCENTS DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1504
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Country | US
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Telephone | 415-507-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 154 IRIS RD
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City | HERCULES
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State | CA
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Zip | 94547-1215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FAMILY SPECIALIST
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Name | ANGELA LOPEZ
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Credential |
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Telephone | 415-507-2000
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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 |
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License Number State |
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