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NPI Code Detail

MEDICARE: JELANI, INC

MEDICARE: JELANI, INC
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
1324500000XSubstance Abuse Rehabilitation Facility380045ENCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C388929OTHERCACALOMS NUMBER

General Provider Information

NPI Number : 1306986377
Entity Type Code : Organization
Provider Name (Legal Business Name) : JELANI, INC
Provider Business Mailing Address
First Line : 1601 QUESADA AVE
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94124-2334
Country : US
Telephone Number : 415-822-5977
Fax Number : 415-822-5943
Provider Business Practice Location Address
First Line : 2261 BRYANT ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94110-2833
Country : US
Telephone Number : 415-206-1560
Fax Number : 415-206-1569
Authorized Official
Title or Position : EXECUTIVE OFFICER
Name : MS. MARGARET GOLD
Credential :
Telephone Number : 415-822-5940
Provider Enumeration Date : 02/07/2007
Last Update Date : 08/22/2020

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