1780241349 NPI number — BAY AREA COMMUNITY RESOURCES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780241349 NPI number — BAY AREA COMMUNITY RESOURCES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA COMMUNITY RESOURCES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MH-WILLOW HS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780241349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11175 SAN PABLO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL CERRITO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94530-2157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-559-3009
Provider Business Mailing Address Fax Number:
510-559-3069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 CROCKETT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROCKETT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94525-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-787-1286
Provider Business Practice Location Address Fax Number:
510-787-2184
Provider Enumeration Date:
05/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BLASKY
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
CHIEF PROGRAM OFFICER
Authorized Official Telephone Number:
415-755-2311

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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