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General NPI Number Information
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NPI Number | 1326384686
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Entity Type | Organization
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Legal Business Name | BAY AREA COMMUNITY RESOURCES, INC.
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 15 SAN MARIN DR
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City | NOVATO
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State | CA
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Zip | 94945-1117
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Country | US
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Telephone | 415-898-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 171 CARLOS DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2005
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Country | US
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Telephone | 415-755-2305
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Fax |
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Authorized Official
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Title or Position | CHIEF PROGRAM OFFICER
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Name | DONALD BRUCE BLASKY
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Credential |
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Telephone | 415-755-2311
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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 |
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License Number State | CA
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