MEDICARE: BERKELEY YOUTH LIVING WITH DISABILITIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

General Provider Information

NPI Number	:	1083744395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERKELEY YOUTH LIVING WITH DISABILITIES

Provider Business Mailing Address
First Line	:	2110 7TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2318
Country	:	US
Telephone Number	:	510-845-2744
Fax Number	:	510-849-1603

Provider Business Practice Location Address
First Line	:	2110 7TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2318
Country	:	US
Telephone Number	:	510-845-2744
Fax Number	:	510-849-1603

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. LUKE FRANCIS KRAMSCHUSTER
Credential	:
Telephone Number	:	510-845-2744

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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