Provider Demographics
NPI:1083744395
Name:BERKELEY YOUTH LIVING WITH DISABILITIES
Entity Type:Organization
Organization Name:BERKELEY YOUTH LIVING WITH DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KRAMSCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-845-2744
Mailing Address - Street 1:2110 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2318
Mailing Address - Country:US
Mailing Address - Phone:510-845-2744
Mailing Address - Fax:510-849-1603
Practice Address - Street 1:2110 7TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2318
Practice Address - Country:US
Practice Address - Phone:510-845-2744
Practice Address - Fax:510-849-1603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities