Provider Demographics
NPI:1437308673
Name:INDEPENDENT LIVING RESOURCES OF SOLANO & CONTRA COSTA COUNTIES
Entity type:Organization
Organization Name:INDEPENDENT LIVING RESOURCES OF SOLANO & CONTRA COSTA COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTCHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-363-7293
Mailing Address - Street 1:1850 GATEWAY BLVD., STE 170
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-8468
Mailing Address - Country:US
Mailing Address - Phone:925-363-7293
Mailing Address - Fax:925-363-7293
Practice Address - Street 1:1850 GATEWAY BLVD., STE 170
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-8468
Practice Address - Country:US
Practice Address - Phone:925-363-7293
Practice Address - Fax:925-363-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHCB00022FMedicare PIN