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General NPI Number Information
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NPI Number | 1922280858
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Entity Type | Organization
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Legal Business Name | SOLID FOUNDATION MANDELA HOUSE
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 6939 MACARTHUR BLVD
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City | OAKLAND
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State | CA
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Zip | 94605-2532
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Country | US
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Telephone | 510-482-6490
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Fax | 510-482-6493
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Provider Business Mailing Address
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Address Line | 2577 MACARTHUR BLVD
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City | OAKLAND
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State | CA
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Zip | 94602-2929
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Country | US
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Telephone | 510-482-6490
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Fax | 510-482-6493
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MINNIE THOMAS
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Credential |
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Telephone | 510-482-6490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 010011FN
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License Number State | CA
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