Provider Demographics
NPI:1215388764
Name:MOMENTUM FOR HEALTH
Entity Type:Organization
Organization Name:MOMENTUM FOR HEALTH
Other - Org Name:ALLIANCE FOR COMMUNITY CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:MINETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:669-213-0755
Mailing Address - Street 1:1922 THE ALAMEDA STE 316
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1461
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-642-6052
Practice Address - Street 1:101 JOSE FIGUERES AVE STE 10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2068
Practice Address - Country:US
Practice Address - Phone:408-207-0565
Practice Address - Fax:408-642-6052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOMENTUM FOR HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-27
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000043DDMedicaid
CAZZZ01125ZOtherMEDICARE ID-TYPE UNSPECIFIED