Provider Demographics
NPI:1982398053
Name:SHARE
Entity Type:Organization
Organization Name:SHARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/CODER
Authorized Official - Prefix:
Authorized Official - First Name:CLESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-745-8276
Mailing Address - Street 1:615 N ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-2152
Mailing Address - Country:US
Mailing Address - Phone:661-369-9595
Mailing Address - Fax:
Practice Address - Street 1:615 N ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-2152
Practice Address - Country:US
Practice Address - Phone:661-369-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No174200000XOther Service ProvidersMeals
No347C00000XTransportation ServicesPrivate Vehicle