=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609388487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNOL HILLS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2017
-----------------------------------------------------
Last Update Date | 11/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 CARVER LN
-----------------------------------------------------
City | SUNOL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94586-9441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-651-5808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39001 SUNDALE DR
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-2005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. HARMOHINDER ATHWAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-651-5808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------