Basic Information
| Provider Information | |||||||||
| NPI: | 1609249994 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AXIS COMMUNITY HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5925 W LAS POSITAS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945888537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254621755 | ||||||||
| FaxNumber: | 9254171503 | ||||||||
| Practice Location | |||||||||
| Address1: | 5925 W LAS POSITAS BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945888537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254621755 | ||||||||
| FaxNumber: | 9254171503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2015 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | COMPTON | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9254621755 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AXIS COMMUNITY HEALTH INC. | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | FHC70205F | 05 | CA | MEDICAID | FHC11593F | 05 | CA | MEDICAID |