NPIMap

Organization Active NPI

Huckleberry Youth Programs

  • Community/Behavioral Health Agency
  • San Anselmo, CA
National Provider Identifier
1609065523
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
210102876 Issued in CA
Legal business name
HUCKLEBERRY YOUTH PROGRAMS
Practice address
9 Grove LN
San Anselmo, CA 94960-2102
Phone
(415) 453-5200
Fax
(415) 453-8418
NPI assigned
Oct 16, 2007
Organization subpart
Yes
Parent organization
HUCKLEBERRY YOUTH PROGRAMSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Virginia Price
Title
Director of Programs and Operations
Phone
(415) 668-2622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 210102876 CA Primary

Addresses

Primary practice location

9 Grove LN
San Anselmo, CA 94960-2102

Mailing address

9 Grove LN
San Anselmo, CA 94960-2102
Phone (415) 453-5200

Other identifiers 1

IdentifierTypeStateIssuer
0000021A1CMedicaidCA

Other names 1

  • Nine Grove Lane Other name

National Provider Directory

National Provider Directory
Tax ID family
Huckleberry Youth Program5 organizations share this tax ID, including this one
Part of
Huckleberry Youth Program

Other organizations with this tax ID 4

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": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1609065523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GROVE LN",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602102",
            "telephone_number": "415-453-5200",
            "fax_number": "415-453-8418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 GROVE LN",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602102",
            "telephone_number": "415-453-5200",
            "fax_number": "415-453-8418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUCKLEBERRY YOUTH PROGRAMS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUCKLEBERRY YOUTH PROGRAMS",
        "enumeration_date": "2007-10-16",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "DIRECTOR OF PROGRAMS AND OPERATIONS",
        "authorized_official_telephone_number": "415-668-2622"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "210102876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000021A1C",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nine Grove Lane",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Anselmo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.