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General NPI Number Information
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NPI Number | 1558178665
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Entity Type | Organization
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Legal Business Name | KINGDOM BUILDERS TRANSITIONAL HOUSING PROGRAM
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 2321 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94601-1018
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Country | US
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Telephone | 510-326-2446
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Fax |
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Provider Business Mailing Address
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Address Line | 2321 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94601-1018
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Country | US
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Telephone | 510-326-2446
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ERNEST L JACKSON
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Credential | DMIN
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Telephone | 415-860-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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