Provider Demographics
NPI:1366624132
Name:SOLID FOUNDATION MANDELA II
Entity Type:Organization
Organization Name:SOLID FOUNDATION MANDELA II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MINNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-482-6490
Mailing Address - Street 1:2577 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2929
Mailing Address - Country:US
Mailing Address - Phone:510-482-6490
Mailing Address - Fax:510-482-6493
Practice Address - Street 1:3408 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2817
Practice Address - Country:US
Practice Address - Phone:510-482-6490
Practice Address - Fax:510-482-6493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010011FN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility