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General NPI Number Information
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NPI Number | 1780726323
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Entity Type | Organization
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Legal Business Name | CCI, INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 39523 SUNDALE DR
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City | FREMONT
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State | CA
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Zip | 94538-1927
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Country | US
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Telephone | 510-623-8231
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Fax | 925-560-0125
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | ALAMO
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State | CA
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Zip | 94507-0112
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Country | US
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Telephone | 925-560-0124
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Fax | 925-560-0125
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL JAMES FISHER
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Credential | M.ED.
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Telephone | 925-560-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | LTC60320F
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License Number State | CA
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