Provider Demographics
NPI:1801201488
Name:NATIONAL PSYCHIATRIC CARE AND REHABILITATION SERVICES
Entity Type:Organization
Organization Name:NATIONAL PSYCHIATRIC CARE AND REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-812-2955
Mailing Address - Street 1:2880 ZANKER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2121
Mailing Address - Country:US
Mailing Address - Phone:415-812-2955
Mailing Address - Fax:
Practice Address - Street 1:4182 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1717
Practice Address - Country:US
Practice Address - Phone:408-826-4058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility