Provider Demographics
NPI:1730538703
Name:FIRST PLACE FOR YOUTH
Entity type:Organization
Organization Name:FIRST PLACE FOR YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-272-0979
Mailing Address - Street 1:426 17TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2814
Mailing Address - Country:US
Mailing Address - Phone:510-272-0979
Mailing Address - Fax:
Practice Address - Street 1:1545 N TEXAS ST STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5623
Practice Address - Country:US
Practice Address - Phone:510-272-0979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487005103253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency