Provider Demographics
NPI:1336239185
Name:CHAMBERLAIN'S DAY CENTER
Entity Type:Organization
Organization Name:CHAMBERLAIN'S DAY CENTER
Other - Org Name:CHAMBERLAIN'S MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:408-843-9504
Mailing Address - Street 1:8352 CHURCH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4449
Mailing Address - Country:US
Mailing Address - Phone:408-848-6511
Mailing Address - Fax:408-848-2099
Practice Address - Street 1:8352 CHURCH ST
Practice Address - Street 2:SUITE C
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4449
Practice Address - Country:US
Practice Address - Phone:408-848-6511
Practice Address - Fax:408-848-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000004357Medicaid