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General NPI Number Information
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NPI Number | 1528327590
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Entity Type | Organization
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Legal Business Name | CENTER FOR INDEPENDENT LIVING, INC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 39350 GALLAUDET DR
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City | FREMONT
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State | CA
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Zip | 94538-2308
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Country | US
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Telephone | 510-794-3666
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Fax | 510-794-2409
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Provider Business Mailing Address
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Address Line | 3075 ADELINE ST SUITE 100
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City | BERKELEY
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State | CA
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Zip | 94703-2579
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Country | US
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Telephone | 510-841-4776
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Fax | 510-841-6168
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | YOMI WRONG
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Credential |
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Telephone | 510-841-4776
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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 |
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