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General NPI Number Information
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NPI Number | 1396936605
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Entity Type | Organization
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Legal Business Name | THE RESOURCE ENVIRONMENT FOR UNDERPRIVILEGED GROUPS ENTERPRISE, INC.
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 4321 TOMPKINS AVE
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City | OAKLAND
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State | CA
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Zip | 94619-2820
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Country | US
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Telephone | 510-301-5809
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19275
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City | OAKLAND
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State | CA
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Zip | 94619-0275
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Country | US
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Telephone | 510-301-5809
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Fax |
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Authorized Official
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Title or Position | EXCEUTIVE DIRECTOR
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Name | MR. JASON B HENDERSON
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Credential |
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Telephone | 510-301-5809
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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 | 015600744
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License Number State | CA
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Taxonomy #2
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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 | 015600412
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License Number State | CA
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