Provider Demographics
NPI:1356629869
Name:SENECA FAMILY OF AGENCIES
Entity Type:Organization
Organization Name:SENECA FAMILY OF AGENCIES
Other - Org Name:SENECA SANTA CLARA CONNECTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-520-0943
Mailing Address - Street 1:8945 GOLF LINKS RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4124
Mailing Address - Country:US
Mailing Address - Phone:510-317-1444
Mailing Address - Fax:
Practice Address - Street 1:485 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4067
Practice Address - Country:US
Practice Address - Phone:408-554-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA FAMILY OF AGENCIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-01
Last Update Date:2023-09-22
Deactivation Date:2023-01-09
Deactivation Code:
Reactivation Date:2023-02-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0015Medicaid
FC577AMedicare PIN