Provider Demographics
NPI:1174948996
Name:SENECA FAMILY OF AGENCIES
Entity type:Organization
Organization Name:SENECA FAMILY OF AGENCIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-520-0943
Mailing Address - Street 1:8945 GOLF LINKS RD.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605
Mailing Address - Country:US
Mailing Address - Phone:510-317-1444
Mailing Address - Fax:
Practice Address - Street 1:200 BROADWAY STREET
Practice Address - Street 2:SUITE 84
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930
Practice Address - Country:US
Practice Address - Phone:510-760-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA FAMILY OF AGENCIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-03
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0015Medicaid
CA0015Medicaid