Provider Demographics
NPI:1912054701
Name:LA CHEIM INC.
Entity type:Organization
Organization Name:LA CHEIM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:510-649-1177
Mailing Address - Street 1:1 BOLIVAR DR
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2210
Mailing Address - Country:US
Mailing Address - Phone:510-649-1177
Mailing Address - Fax:510-649-0322
Practice Address - Street 1:1 BOLIVAR DR
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2210
Practice Address - Country:US
Practice Address - Phone:510-649-1177
Practice Address - Fax:510-649-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
CA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261QM0855XOtherADOLESCENT, CHILD MS
CA261QM0850XOtherADULT MENTAL HEALTH
CA322D00000XOtherRESIDENTIAL TREATMENT