Provider Demographics
NPI:1043252661
Name:JEWISH FAMILY & COMMUNITY SERVICES EAST BAY
Entity Type:Organization
Organization Name:JEWISH FAMILY & COMMUNITY SERVICES EAST BAY
Other - Org Name:JEWISH FAMILY & CHILDREN'S SERVICES OF THE EAST BAY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. JULIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-704-7475
Mailing Address - Street 1:2484 SHATTUCK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2076
Mailing Address - Country:US
Mailing Address - Phone:510-704-7475
Mailing Address - Fax:510-704-7494
Practice Address - Street 1:2484 SHATTUCK AVE
Practice Address - Street 2:210
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2076
Practice Address - Country:US
Practice Address - Phone:510-704-0747
Practice Address - Fax:510-704-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ15557Z251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15557ZMedicare PIN
ZZZ15557ZMedicare PIN