Provider Demographics
NPI:1366895666
Name:LIFEMOVES - AUTUMN SATELLITE CLINIC
Entity type:Organization
Organization Name:LIFEMOVES - AUTUMN SATELLITE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-685-5880
Mailing Address - Street 1:181 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1106
Mailing Address - Country:US
Mailing Address - Phone:650-685-5880
Mailing Address - Fax:
Practice Address - Street 1:263 N AUTUMN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110
Practice Address - Country:US
Practice Address - Phone:650-685-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEMOVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-21
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management