Provider Demographics
NPI:1114138773
Name:EAST BAY COMMUNTIY ACTION PROGRAM
Entity Type:Organization
Organization Name:EAST BAY COMMUNTIY ACTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RILWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEYISITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-848-6697
Mailing Address - Street 1:19 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2937
Mailing Address - Country:US
Mailing Address - Phone:401-848-6697
Mailing Address - Fax:401-841-0264
Practice Address - Street 1:19 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2937
Practice Address - Country:US
Practice Address - Phone:401-848-6697
Practice Address - Fax:401-841-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency