Provider Demographics
NPI:1588806996
Name:PRESCOTT-JOSEPH CENTER FOR COMMUNITY ENHANCEMENT, INC.
Entity Type:Organization
Organization Name:PRESCOTT-JOSEPH CENTER FOR COMMUNITY ENHANCEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WASHINGTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-208-5651
Mailing Address - Street 1:920 PERALTA ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-1926
Mailing Address - Country:US
Mailing Address - Phone:510-208-5651
Mailing Address - Fax:510-208-2801
Practice Address - Street 1:920 PERALTA ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-1926
Practice Address - Country:US
Practice Address - Phone:510-208-5651
Practice Address - Fax:510-208-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty