Provider Demographics
NPI:1881813905
Name:HARDWICK, JAMES NOLAN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:NOLAN
Last Name:HARDWICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4673 THORNTON AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5663
Mailing Address - Country:US
Mailing Address - Phone:510-791-9048
Mailing Address - Fax:510-791-0939
Practice Address - Street 1:199 HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4209
Practice Address - Country:US
Practice Address - Phone:530-885-9067
Practice Address - Fax:530-885-2534
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310007CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3105Medicare ID - Type UnspecifiedNEW LEAF RES HOFFMAN