NPIMap

Organization Active NPI

Nba Serra Residential Center

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fremont, CA
National Provider Identifier
1356487532
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
0200319 Issued in CA
Legal business name
NBA SERRA RESIDENTIAL CENTER
Practice address
39055 Hastings St Ste 211
Fremont, CA 94538-1518
Phone
(510) 608-3900
Fax
(510) 608-3914
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ann C Stafford
Title
Chief Financial Officer
Phone
(573) 876-7302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 0200319 CA Primary

Addresses

Primary practice location

39055 Hastings St Ste 211
Fremont, CA 94538-1518

Mailing address

39055 Hastings St Ste 211
Fremont, CA 94538-1518
Phone (510) 608-3900

Other identifiers 1

IdentifierTypeStateIssuer
LTC60284FMedicaidCA

Other names 1

  • SERRA CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Nba Serra Residential Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356487532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39055 HASTINGS ST STE 211",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381518",
            "telephone_number": "510-608-3900",
            "fax_number": "510-608-3914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39055 HASTINGS ST STE 211",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381518",
            "telephone_number": "510-608-3900",
            "fax_number": "510-608-3914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NBA SERRA RESIDENTIAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAFFORD",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "573-876-7302"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "0200319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60284F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SERRA CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.