Basic Information
| Provider Information | |||||||||
| NPI: | 1487187951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER NEW BEGINNINGS YOUTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 FILBERT ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946072890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106639092 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1625 FILBERT ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946072890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106639092 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2017 | ||||||||
| LastUpdateDate: | 07/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | PORTER | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5107193950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 015600316 | CA | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.