1972026672 NPI number — ALZHEIMER'S SERVICES OF THE EAST BAY, INCORPORATED

Table of content: (NPI 1972026672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972026672 NPI number — ALZHEIMER'S SERVICES OF THE EAST BAY, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALZHEIMER'S SERVICES OF THE EAST BAY, INCORPORATED
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:
Provider Other Organization Name Type Code:
6
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:
1972026672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2320 CHANNING WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94704-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-644-8292
Provider Business Mailing Address Fax Number:
510-540-6771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43326 MISSION BLVD STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94539-5829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-656-1329
Provider Business Practice Location Address Fax Number:
510-656-1418
Provider Enumeration Date:
07/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
POPE
Authorized Official First Name:
MICHEAL
Authorized Official Middle Name:
Authorized Official Title or Position:
CE
Authorized Official Telephone Number:
510-644-8292

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  550003551 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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