Provider Demographics
NPI:1457097065
Name:SENECA FAMILY OF AGENCIES
Entity Type:Organization
Organization Name:SENECA FAMILY OF AGENCIES
Other - Org Name:SF ASPIRE STRTP
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 1:2275 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1132
Mailing Address - Country:US
Mailing Address - Phone:510-317-1444
Mailing Address - Fax:
Practice Address - Street 1:2515 24TH ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3564
Practice Address - Country:US
Practice Address - Phone:415-805-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA FAMILY OF AGENCIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-06
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0015Medicaid