Provider Demographics
NPI:1457474959
Name:UJIMA FAMILY RECOVERY SERVICES
Entity Type:Organization
Organization Name:UJIMA FAMILY RECOVERY SERVICES
Other - Org Name:LA CASA UJIMA 919 MELLUS STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHANK
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:510-236-3139
Mailing Address - Street 1:1901 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3707
Mailing Address - Country:US
Mailing Address - Phone:510-236-3139
Mailing Address - Fax:510-236-3200
Practice Address - Street 1:919 MELLUS ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1744
Practice Address - Country:US
Practice Address - Phone:925-229-0230
Practice Address - Fax:925-229-0233
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UJIMA FAMILY RECOVERY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070008DN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility