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General NPI Number Information
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NPI Number | 1700132164
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Entity Type | Organization
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Legal Business Name | YOUTHALIVE
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 3300 ELM ST
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City | OAKLAND
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State | CA
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Zip | 94609-3012
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Country | US
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Telephone | 510-594-2588
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Fax | 510-594-0667
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Provider Business Mailing Address
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Address Line | 3300 ELM ST
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City | OAKLAND
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State | CA
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Zip | 94609-3012
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Country | US
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Telephone | 510-594-2588
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Fax | 510-594-0667
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANNE MARKS
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Credential | MPP
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Telephone | 510-594-2588
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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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