Provider Demographics
NPI:1003189614
Name:INTERIM INC
Entity Type:Organization
Organization Name:INTERIM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WELLNESS RECOVERY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-562-7800
Mailing Address - Street 1:412 DELA VINA AVE
Mailing Address - Street 2:APT 30
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3962
Mailing Address - Country:US
Mailing Address - Phone:660-562-7800
Mailing Address - Fax:
Practice Address - Street 1:604 PEARL ST
Practice Address - Street 2:INTERIM INC
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3070
Practice Address - Country:US
Practice Address - Phone:816-649-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness