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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
SAM COBBS (CHIEF EXECUTIVE OFFICER)
(510) 272-0979
Entity
Organization

Contact information

Practice address
1545 N TEXAS ST STE 100, FAIRFIELD, CA 94533-5623
(510) 272-0979
Mailing address
426 17TH ST STE 100, OAKLAND, CA 94612-2814
(510) 272-0979

Taxonomy

Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
487005103
CA

Other

Enumeration date
06/09/2016
Last updated
06/09/2016
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