Provider Demographics
NPI:1083885917
Name:ALAMEDA HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALAMEDA HEALTH SYSTEM
Other - Org Name:JOHN GEORGE PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
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 1:2060 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1001
Practice Address - Country:US
Practice Address - Phone:510-346-7500
Practice Address - Fax:510-346-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000046283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050320Medicare Oscar/Certification
05S320Medicare Oscar/Certification