Provider Demographics
NPI:1598412041
Name:URBAN TILTH
Entity Type:Organization
Organization Name:URBAN TILTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-932-1059
Mailing Address - Street 1:323 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-1301
Mailing Address - Country:US
Mailing Address - Phone:510-232-0911
Mailing Address - Fax:
Practice Address - Street 1:323 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-1301
Practice Address - Country:US
Practice Address - Phone:510-232-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No174200000XOther Service ProvidersMeals