Provider Demographics
NPI:1225251499
Name:CSG BETTER HEARING SERVICES, INC., A PROFESSIONAL AUDIOLOGY CORP.
Entity Type:Organization
Organization Name:CSG BETTER HEARING SERVICES, INC., A PROFESSIONAL AUDIOLOGY CORP.
Other - Org Name:CSG BETTER HEARING, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:925-938-8686
Mailing Address - Street 1:2316 DWIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2212
Mailing Address - Country:US
Mailing Address - Phone:510-862-3449
Mailing Address - Fax:
Practice Address - Street 1:2316 DWIGHT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2212
Practice Address - Country:US
Practice Address - Phone:510-862-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1138231H00000X
CAHA2506237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171779400OtherDEPT OF LABOR
CAHA0025060OtherBLUE SHIELD
CAAU0011380OtherUNITED HEALTHCARE
CAAU0011380Medicaid
CAZZZ227052Medicare ID - Type Unspecified