Basic Information
| Provider Information | |||||||||
| NPI: | 1447705280 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA COMMUNITY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 629 OAKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946114567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106130330 | ||||||||
| FaxNumber: | 5105694589 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 ALABAMA ST | ||||||||
| Address2: | |||||||||
| City: | VALLEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945904446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106130330 | ||||||||
| FaxNumber: | 5105694589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2016 | ||||||||
| LastUpdateDate: | 05/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | ALMANZA | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
| AuthorizedOfficialMiddleName: | LEILANI | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5104154672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | 486803637 | CA | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 000008128 | 05 | CA | MEDICAID |