Provider Demographics
NPI:1851681035
Name:SENECA FAMILY OF AGENCIES
Entity Type:Organization
Organization Name:SENECA FAMILY OF AGENCIES
Other - Org Name:CRAGMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-520-0935
Mailing Address - Street 1:2275 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1132
Mailing Address - Country:US
Mailing Address - Phone:415-407-4558
Mailing Address - Fax:
Practice Address - Street 1:830 REGAL RD RM 207
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94708-1308
Practice Address - Country:US
Practice Address - Phone:510-317-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA FAMILY OF AGENCIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0015Medicaid
CA0015Medicaid