Provider Demographics
NPI:1013231646
Name:ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY/HEALTH CARE FOR HOMELESS
Entity Type:Organization
Organization Name:ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY/HEALTH CARE FOR HOMELESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MODERSBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-532-1930
Mailing Address - Street 1:1900 FRUITVALE AVE STE 3E
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2469
Mailing Address - Country:US
Mailing Address - Phone:510-532-1930
Mailing Address - Fax:510-532-0963
Practice Address - Street 1:2272 SAN PABLO AVE
Practice Address - Street 2:HCHP ST.VINCENT'S STABLE SITE CLINIC
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1321
Practice Address - Country:US
Practice Address - Phone:510-532-1930
Practice Address - Fax:510-532-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881632867OtherORIGINAL NPI