Provider Demographics
NPI:1356907315
Name:BAY AREA ADDICTION SERVICES
Entity type:Organization
Organization Name:BAY AREA ADDICTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC, CARN, RN
Authorized Official - Phone:800-913-7917
Mailing Address - Street 1:270 PALM VALLEY BLVD APT 105
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1047
Mailing Address - Country:US
Mailing Address - Phone:800-913-7917
Mailing Address - Fax:
Practice Address - Street 1:2039 FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4815
Practice Address - Country:US
Practice Address - Phone:800-913-7917
Practice Address - Fax:866-828-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty