Provider Demographics
NPI:1376952515
Name:PORTIA BELL HUME BEHAVIORAL HEALTH AND TRAINING CENTER
Entity Type:Organization
Organization Name:PORTIA BELL HUME BEHAVIORAL HEALTH AND TRAINING CENTER
Other - Org Name:HUME CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATAIVE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAWADA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJADDIDI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-745-9151
Mailing Address - Street 1:39420 LIBERTY ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2200
Mailing Address - Country:US
Mailing Address - Phone:510-745-9151
Mailing Address - Fax:
Practice Address - Street 1:39420 LIBERTY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2200
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty