Organization
BERKELEY ADDICTION TERATMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK TISHMAN (FISCAL OFFICER)
(510) 644-0200
Entity
Organization
Contact information
Practice address
2975 SACRAMENTO ST, BERKELEY, CA 94702-2534
(510) 644-0200
Mailing address
2975 SACRAMENTO ST, BERKELEY, CA 94702-2534
(510) 644-0200
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
0190
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YA0400X
MEDICAL
CA
Enumeration date
09/28/2015
Last updated
09/28/2015
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