Provider Demographics
NPI:1952807695
Name:LIFEMOVES - MONTGOMERY STREET INN
Entity Type:Organization
Organization Name:LIFEMOVES - MONTGOMERY STREET INN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-685-5880
Mailing Address - Street 1:358 N MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2325
Mailing Address - Country:US
Mailing Address - Phone:408-271-5160
Mailing Address - Fax:
Practice Address - Street 1:358 N MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110
Practice Address - Country:US
Practice Address - Phone:408-271-5160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEMOVES - AUTUMN SATELLITE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-02
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty