Organization
COMMUNITY LIFE SKILLS AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA CAROL HANSSON BACHELOR OF SCIENCE (CEO/PROGRAM DIRECTOR)
(800) 398-9141
Entity
Organization
Contact information
Practice address
5920 THORNTON AVE STE C, NEWARK, CA 94560-3843
(800) 398-9141
(510) 745-0105
Mailing address
5920 THORNTON AVE STE C, NEWARK, CA 94560-3843
(800) 398-9141
(510) 745-0105
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
C3922881
CA
Other
Enumeration date
12/06/2017
Last updated
12/06/2017
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