Provider Demographics
NPI:1376894519
Name:FREMONT HIGH SCHOOL
Entity Type:Organization
Organization Name:FREMONT HIGH SCHOOL
Other - Org Name:ALLIANT INTERNATIONAL UNIVERSITY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILNES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-628-9065
Mailing Address - Street 1:1440 BROADWAY STE 610
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4610 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-4618
Practice Address - Country:US
Practice Address - Phone:510-879-1137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health