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General NPI Number Information
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NPI Number | 1902117450
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Entity Type | Organization
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Legal Business Name | SUBACUTE TREATMENT FOR ADOLESCENT REHABILITATION SERVICES, INC.
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1510 VIA SONYA
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City | SAN LORENZO
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State | CA
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Zip | 94580-2760
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Country | US
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Telephone | 510-317-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 400 ESTUDILLO AVE STE 100
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4962
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CHIEF EXECUTIVE OFFIC
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Name | KENT DUNLAP
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Credential |
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Telephone | 310-221-6336
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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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