=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659518033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BI-BETT CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2009
-----------------------------------------------------
Last Update Date | 01/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 604 BROADWAY ST
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94590-3323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-643-2748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3018 WILLOW PASS RD 102
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94519-2598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-798-7250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. SUSAN CINELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-798-7250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 480002GN
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------