Provider Demographics
NPI:1821665431
Name:CHANGE TO COME
Entity Type:Organization
Organization Name:CHANGE TO COME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-203-8493
Mailing Address - Street 1:PO BOX 1712
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-0171
Mailing Address - Country:US
Mailing Address - Phone:415-203-8493
Mailing Address - Fax:
Practice Address - Street 1:685 32ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2987
Practice Address - Country:US
Practice Address - Phone:415-996-5177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility