Provider Demographics
NPI:1942590120
Name:SENECA FAMILY OF AGENCIES
Entity Type:Organization
Organization Name:SENECA FAMILY OF AGENCIES
Other - Org Name:BERKELEY HIGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-725-5727
Mailing Address - Street 1:6925 CHABOT RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1921
Mailing Address - Country:US
Mailing Address - Phone:510-654-4004
Mailing Address - Fax:
Practice Address - Street 1:1980 ALLSTON WAY BLDG C
Practice Address - Street 2:CLASSROOM C116, C134. C132. C338
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1463
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:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0015Medicaid
FC577AMedicare PIN