Provider Demographics
NPI:1144744186
Name:NATIONAL PSYCHIATRIC CARE AND REHABILITATION SERVICES
Entity Type:Organization
Organization Name:NATIONAL PSYCHIATRIC CARE AND REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-812-2955
Mailing Address - Street 1:2860 ZANKER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2119
Mailing Address - Country:US
Mailing Address - Phone:415-812-2955
Mailing Address - Fax:
Practice Address - Street 1:1532 ROSALIND ST STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-4535
Practice Address - Country:US
Practice Address - Phone:408-688-4737
Practice Address - Fax:408-521-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility