Provider Demographics
NPI:1275847410
Name:STANDFOR FAMILES FREE OF VIOLANCE
Entity Type:Organization
Organization Name:STANDFOR FAMILES FREE OF VIOLANCE
Other - Org Name:STAND AGAINST DOMESTIC VIOLENCE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-603-0112
Mailing Address - Street 1:1410 DANZIG PLZ
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7979
Mailing Address - Country:US
Mailing Address - Phone:925-676-2845
Mailing Address - Fax:925-676-0274
Practice Address - Street 1:315 G ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1254
Practice Address - Country:US
Practice Address - Phone:925-706-8477
Practice Address - Fax:925-706-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health