Basic Information
| Provider Information | |||||||||
| NPI: | 1801088059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LINCOLN CHILD CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3524 FOOTHILL BLVD APT 9 | ||||||||
| Address2: | 3524 FOOTHILL BLVD APT 9 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946013644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105313111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3524 FOOTHILL BLVD APT 9 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946013644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105313111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | ZINDANI | ||||||||
| AuthorizedOfficialFirstName: | BILAL | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | SHIFT LEADER | ||||||||
| AuthorizedOfficialTelephone: | 5105313111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | I | ||||||||
| AuthorizedOfficialCredential: | BA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 1Q1Y0800X | CA | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.