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General NPI Number Information
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NPI Number | 1629438775
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Entity Type | Organization
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Legal Business Name | A.K. BEAN FOUNDATION
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 2100 SACRAMENTO ST
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City | VALLEJO
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State | CA
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Zip | 94590-3126
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Country | US
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Telephone | 707-642-4789
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Fax | 707-642-8882
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Provider Business Mailing Address
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Address Line | 2100 SACRAMENTO ST
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City | VALLEJO
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State | CA
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Zip | 94590-3126
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Country | US
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Telephone | 707-642-8947
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Fax | 707-429-1908
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MS. DENEE MARIE TYSOL
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Credential | SUDRC
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Telephone | 707-664-7798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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