=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265023915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MSK SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2021
-----------------------------------------------------
Last Update Date | 01/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1116 LEGEND CIR
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94591-8679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-647-3972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3871 QUARRYVILLE CT
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94533-6651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-681-7988
-----------------------------------------------------
Fax | 510-323-8066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. TEGRE MILES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-681-7988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253J00000X
-----------------------------------------------------
Taxonomy Name | Foster Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------