Provider Demographics
NPI:1497184238
Name:SHARE HOMES
Entity Type:Organization
Organization Name:SHARE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-327-0588
Mailing Address - Street 1:210 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-2122
Mailing Address - Country:US
Mailing Address - Phone:209-334-6376
Mailing Address - Fax:
Practice Address - Street 1:210 N SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-2122
Practice Address - Country:US
Practice Address - Phone:209-334-6376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health