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General NPI Number Information
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NPI Number | 1356487532
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Entity Type | Organization
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Legal Business Name | NBA SERRA RESIDENTIAL CENTER
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 39055 HASTINGS ST STE 211
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City | FREMONT
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State | CA
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Zip | 94538-1518
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Country | US
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Telephone | 510-608-3900
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Fax | 510-608-3914
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Provider Business Mailing Address
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Address Line | 39055 HASTINGS ST STE 211
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City | FREMONT
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State | CA
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Zip | 94538-1518
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Country | US
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Telephone | 510-608-3900
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Fax | 510-608-3914
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ANN C STAFFORD
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Credential |
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Telephone | 573-876-7302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 0200319
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License Number State | CA
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