NPIMap

Organization Active NPI

General Assembly of the Christian Church

Doing business as Nba Serra Center

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fremont, CA
National Provider Identifier
1952447765
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
020000402 Issued in CA
Legal business name
GENERAL ASSEMBLY OF THE CHRISTIAN CHURCH
Doing business as
Nba Serra Center
Practice address
4066 Bonde Way
Fremont, CA 94536-4801
Phone
(610) 608-3900
Fax
(510) 608-3914
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

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 020000402 CA Primary

Addresses

Primary practice location

4066 Bonde Way
Fremont, CA 94536-4801

Mailing address

4066 Bonde Way
Fremont, CA 94536-4801
Phone (610) 608-3900

Other identifiers 1

IdentifierTypeStateIssuer
LTC60517FMedicaidCA

Other names 1

  • NBA 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.

Locations

4066 Bonde Way
Fremont, CA 94536
Phone (510) 818-1350

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": "1215734400000",
    "number": "1952447765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4066 BONDE WAY",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364801",
            "telephone_number": "610-608-3900",
            "fax_number": "510-608-3914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4066 BONDE WAY",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364801",
            "telephone_number": "610-608-3900",
            "fax_number": "510-608-3914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERAL ASSEMBLY OF THE CHRISTIAN CHURCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2008-07-11",
        "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": "020000402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60517F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NBA 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 Jul 11, 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.