=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528240959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARNELES UNIDOS REFORMANDO ADICTOS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2007
-----------------------------------------------------
Last Update Date | 11/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 24TH ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94612-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-839-2525
-----------------------------------------------------
Fax | 510-663-8982
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4510 PERALTA BLVD SUITE 1
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94536-5755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-713-3202
-----------------------------------------------------
Fax | 510-713-0684
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDANT/CEO
-----------------------------------------------------
Name | MR. JOSEPH B LOCARIA
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 510-713-3202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 010010CN
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------