Provider Demographics
NPI:1639497670
Name:CENTER POINT RESIDENTIAL PROGRAM
Entity Type:Organization
Organization Name:CENTER POINT RESIDENTIAL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-526-2941
Mailing Address - Street 1:207 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3739
Mailing Address - Country:US
Mailing Address - Phone:415-454-9444
Mailing Address - Fax:
Practice Address - Street 1:207 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3739
Practice Address - Country:US
Practice Address - Phone:415-454-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER POINT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210002KN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility