Basic Information
| Provider Information | |||||||||
| NPI: | 1306037981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA COMMUNITY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 40TH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946092633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106130330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 629 OAKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946114567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106589480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | STANTON | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR DIRECTOR OF ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 5102197451 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 22083 | CA | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 01EM1 | 05 | CA | MEDICAID |