Provider Demographics
NPI:1497414585
Name:JERICHO PROJECT
Entity Type:Organization
Organization Name:JERICHO PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:SUDCC 3-CS
Authorized Official - Phone:415-306-4301
Mailing Address - Street 1:PO BOX 2367
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-2367
Mailing Address - Country:US
Mailing Address - Phone:650-515-2828
Mailing Address - Fax:
Practice Address - Street 1:430 VALLEY DR
Practice Address - Street 2:
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005-1210
Practice Address - Country:US
Practice Address - Phone:415-656-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility