Provider Demographics
NPI:1164973491
Name:THE WEST OAKLAND HEALTH COUNCIL
Entity Type:Organization
Organization Name:THE WEST OAKLAND HEALTH COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PETTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-835-9610
Mailing Address - Street 1:7501 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2843
Mailing Address - Country:US
Mailing Address - Phone:510-729-8800
Mailing Address - Fax:510-569-4965
Practice Address - Street 1:8251 FONTAINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4109
Practice Address - Country:US
Practice Address - Phone:510-636-7992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WEST OAKLAND HEALTH COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-21
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health