Organization
PORTSMOUTH
Active
Other names
Portsmouth ICF DDH
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MONES JOHN MOHSENI (PROVIDER)
(510) 909-4476
Entity
Organization
Contact information
Practice address
27695 PORTSMOUTH AVENUE, HAYWARD, CA 94545
(510) 909-4476
(510) 538-7892
Mailing address
27695 PORTSMOUTH AVENUE, HAYWARD, CA 94545
(510) 909-4476
(510) 538-7892
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HB0022
REGION CENTER OF EAST BAY
CA
Enumeration date
02/13/2007
Last updated
08/22/2020
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