Basic Information
| Provider Information | |||||||||
| NPI: | 1215501580 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PACT, AN ADOPTION ALLIANCE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PACT, AN ADOPTION ALLIANCE | ||||||||
| Address2: | 5515 DOYLE STREET SUITE #1 | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946082548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102439460 | ||||||||
| FaxNumber: | 5102439970 | ||||||||
| Practice Location | |||||||||
| Address1: | PACT, AN ADOPTION ALLIANCE | ||||||||
| Address2: | 5515 DOYLE STREET SUITE #1 | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946082548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102439460 | ||||||||
| FaxNumber: | 5102439970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2021 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH (BETH) | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5102439460 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.