=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942374426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENECA CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1034 OAK GROVE RD
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94518-3225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-603-1944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3234 OHIO AVE
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94804-3069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-684-4338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESIDENITAL THERAPIST
-----------------------------------------------------
Name | LUCY NDEGO JITE-OGBUEHI
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 925-603-1944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 19298
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------