Organization
NBA SERRA RESIDENTAL CENTER
Active
Other names
SERRA CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
ANN C STAFFORD (CHIEF FINANCIAL OFFICER)
(573) 876-7302
Entity
Organization
Contact information
Practice address
39055 HASTINGS ST STE 211, FREMONT, CA 94538-1518
(510) 608-3900
(510) 608-3914
Mailing address
39055 HASTINGS ST STE 211, FREMONT, CA 94538-1518
(510) 608-3900
(510) 608-3914
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
0200520
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60743F
—
CA
Enumeration date
01/29/2007
Last updated
08/22/2020
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