Organization
LIFELONG JENKINS PEDIATRIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICK CLARK (CHIEF FINANCIAL OFFICER)
(510) 981-4122
Entity
Organization
Contact information
Practice address
120 BROADWAY, SUITE 4, RICHMOND, CA 94804-1938
(510) 237-9537
(510) 237-3957
Mailing address
PO BOX 11247, BERKELEY, CA 94712-2247
(510) 981-4122
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/25/2012
Last updated
10/25/2012
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