Provider Demographics
NPI:1053657569
Name:FIRST RESORT
Entity Type:Organization
Organization Name:FIRST RESORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JANAY
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:510-569-1200
Mailing Address - Street 1:1933 DAVIS ST
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1260
Mailing Address - Country:US
Mailing Address - Phone:510-569-1200
Mailing Address - Fax:
Practice Address - Street 1:400 30TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3306
Practice Address - Country:US
Practice Address - Phone:510-891-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000330261QC1500X
CA220000477261QC1500X
CA220000395261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health