Provider Demographics
NPI:1275623803
Name:LA CHEIM SCHOOL INC
Entity Type:Organization
Organization Name:LA CHEIM SCHOOL INC
Other - Org Name:LA CHEIM BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:510-222-0292
Mailing Address - Street 1:2853 GROOM DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-2664
Mailing Address - Country:US
Mailing Address - Phone:510-223-4393
Mailing Address - Fax:510-262-1502
Practice Address - Street 1:13201 SAN PABLO AVE
Practice Address - Street 2:SUITE # 303
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3952
Practice Address - Country:US
Practice Address - Phone:510-231-2300
Practice Address - Fax:510-237-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000663251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA054656Medicare Oscar/Certification