Provider Demographics
NPI:1528221678
Name:ADULT FULL SERVICE PARTNERSHIP
Entity Type:Organization
Organization Name:ADULT FULL SERVICE PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:HIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-253-4279
Mailing Address - Street 1:2751 NAPA VALLEY CORPORATE DR
Mailing Address - Street 2:HHS - FISCAL DIVISION BLDG B
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6216
Mailing Address - Country:US
Mailing Address - Phone:707-253-4662
Mailing Address - Fax:707-299-4163
Practice Address - Street 1:2751 NAPA VALLEY CORPORATE DR
Practice Address - Street 2:BLDGS - A & B
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6216
Practice Address - Country:US
Practice Address - Phone:707-253-4662
Practice Address - Fax:707-299-4163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAPA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-09
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2800028Medicaid
BU669ZOtherMEDICARE
CAZZZ49617ZMedicare PIN