Provider Demographics
NPI:1558197772
Name:SOLANO PRIDE CENTER
Entity type:Organization
Organization Name:SOLANO PRIDE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-200-7916
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0031
Mailing Address - Country:US
Mailing Address - Phone:707-207-3430
Mailing Address - Fax:
Practice Address - Street 1:1234 EMPIRE ST STE 1560
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5711
Practice Address - Country:US
Practice Address - Phone:707-207-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty