Provider Demographics
NPI:1023219821
Name:ALAMEDA HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALAMEDA HEALTH SYSTEM
Other - Org Name:HAYWARD WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-618-2147
Mailing Address - Street 1:15400 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1009
Mailing Address - Country:US
Mailing Address - Phone:510-895-7344
Mailing Address - Fax:510-895-7229
Practice Address - Street 1:664 SOUTHLAND MALL
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2150
Practice Address - Country:US
Practice Address - Phone:510-266-1700
Practice Address - Fax:510-782-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAEXEMPT UNDER 12-35B261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77817ZMedicare ID - Type UnspecifiedWINTON WELLNESS CENTER