Provider Demographics
NPI:1134643828
Name:EAST BAY AGENCEY FOR CHILDREN
Entity Type:Organization
Organization Name:EAST BAY AGENCEY FOR CHILDREN
Other - Org Name:SAN LEANDRO HIGH CE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CQI
Authorized Official - Prefix:
Authorized Official - First Name:MAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNABIKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-268-3770
Mailing Address - Street 1:303 VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:991 14TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3230
Practice Address - Country:US
Practice Address - Phone:510-268-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST BAY AGENCEY FOR CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health