Provider Demographics
NPI:1770789901
Name:INDEPENDENT LIVING RESOURCE OF CONTRA COSTA COUNTY
Entity type:Organization
Organization Name:INDEPENDENT LIVING RESOURCE OF CONTRA COSTA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-363-7293
Mailing Address - Street 1:3200 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2819
Mailing Address - Country:US
Mailing Address - Phone:925-363-7293
Mailing Address - Fax:925-363-7296
Practice Address - Street 1:3200 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2819
Practice Address - Country:US
Practice Address - Phone:925-363-7293
Practice Address - Fax:925-363-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management