Provider Demographics
NPI:1770920886
Name:ROTACARE RICHMOND FREE MEDICAL CLINIC AT BRIGHTER BEGINNINGS
Entity type:Organization
Organization Name:ROTACARE RICHMOND FREE MEDICAL CLINIC AT BRIGHTER BEGINNINGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-903-7516
Mailing Address - Street 1:2727 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3006
Mailing Address - Country:US
Mailing Address - Phone:510-903-7516
Mailing Address - Fax:510-213-6680
Practice Address - Street 1:2727 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-3006
Practice Address - Country:US
Practice Address - Phone:510-903-7516
Practice Address - Fax:510-213-6680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROTACARE BAY AREA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11694251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable