Basic Information
| Provider Information | |||||||||
| NPI: | 1265553465 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UJIMA FAMILY RECOVER SERVICES | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | UJIMA EAST OUTPATIENT PROGRAM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 CHURCH LANE | ||||||||
| Address2: | |||||||||
| City: | SAN PABLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948063707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102363139 | ||||||||
| FaxNumber: | 5102363200 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 E. LELAND RD. | ||||||||
| Address2: | SUITES A&B | ||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945654949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254279100 | ||||||||
| FaxNumber: | 9254279102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHANK | ||||||||
| AuthorizedOfficialFirstName: | RITA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5102363139 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UJIMA FAMILY RECOVER SERVICES | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 070008EN | CA | N | Agencies | Community/Behavioral Health | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.