Provider Demographics
NPI:1497410286
Name:COMMITTEE ON THE SHELTERLESS
Entity Type:Organization
Organization Name:COMMITTEE ON THE SHELTERLESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:707-765-6530
Mailing Address - Street 1:900 HOPPER ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3388
Mailing Address - Country:US
Mailing Address - Phone:707-765-6530
Mailing Address - Fax:
Practice Address - Street 1:900 HOPPER ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3388
Practice Address - Country:US
Practice Address - Phone:707-765-6530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage