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General NPI Number Information
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NPI Number | 1962781724
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Entity Type | Organization
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Legal Business Name | PUWRA
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 1450 CHAPIN AVENUE SUITE 1
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City | BURLINGAME
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State | CA
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Zip | 94010
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Country | US
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Telephone | 650-348-6603
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Fax | 650-348-0615
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Provider Business Mailing Address
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Address Line | 1450 CHAPIN AVE
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City | BURLINGAME
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State | CA
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Zip | 94010-4062
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Country | US
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Telephone | 650-348-6603
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Fax | 650-348-0615
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Authorized Official
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Title or Position | PUBLIC ASSISTANCE COORDINATOR
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Name | MISS ROBERTA MARIE ALLEN
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Credential |
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Telephone | 650-348-6603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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