Provider Demographics
NPI:1366996159
Name:BIBETT CORPORATION
Entity type:Organization
Organization Name:BIBETT CORPORATION
Other - Org Name:<UNAVAIL>
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:CINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-798-7250
Mailing Address - Street 1:2290 DIAMOND BLVD
Mailing Address - Street 2:#200
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-8107
Mailing Address - Country:US
Mailing Address - Phone:925-798-7250
Mailing Address - Fax:925-798-3359
Practice Address - Street 1:1342 E 27TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-3266
Practice Address - Country:US
Practice Address - Phone:510-535-0611
Practice Address - Fax:510-535-1358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIBETT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT0501030950OtherACCBC