Provider Demographics
NPI: | 1497940134 |
---|---|
Name: | BERKELEY ADDICTION TREATMENT SERVICES |
Entity Type: | Organization |
Organization Name: | BERKELEY ADDICTION TREATMENT SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | MATONIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WILLIAMS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 510-644-0200 |
Mailing Address - Street 1: | 2975 SACRAMENTO ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BERKELEY |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94702-2534 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 510-644-0200 |
Mailing Address - Fax: | 510-644-2044 |
Practice Address - Street 1: | 2975 SACRAMENTO ST |
Practice Address - Street 2: | |
Practice Address - City: | BERKELEY |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94702-2534 |
Practice Address - Country: | US |
Practice Address - Phone: | 510-644-0200 |
Practice Address - Fax: | 510-644-2044 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-09-06 |
Last Update Date: | 2007-09-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 01/90 | 332900000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332900000X | Suppliers | Non-Pharmacy Dispensing Site |