Basic Information
| Provider Information | |||||||||
| NPI: | 1831488311 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ED SUPPORT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 EMBARCADERO | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946065231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108324383 | ||||||||
| FaxNumber: | 5105501981 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 EMBARCADERO | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946065231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108324383 | ||||||||
| FaxNumber: | 5105501981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | AKERS | ||||||||
| AuthorizedOfficialFirstName: | MEREDITH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5108324383 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 103K00000X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.