Provider Demographics
NPI:1912995143
Name:COMPANY FOR HEALTHY LIVING
Entity Type:Organization
Organization Name:COMPANY FOR HEALTHY LIVING
Other - Org Name:CHL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-354-6783
Mailing Address - Street 1:2880 ZANKER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2117
Mailing Address - Country:US
Mailing Address - Phone:408-354-6783
Mailing Address - Fax:831-335-2118
Practice Address - Street 1:2880 ZANKER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2117
Practice Address - Country:US
Practice Address - Phone:408-354-6783
Practice Address - Fax:831-335-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700993342Medicare PIN
1720122906Medicare PIN
1487797445Medicare PIN
1912995143Medicare PIN