Provider Demographics
NPI:1417311234
Name:EAST BAY AGENCY FOR CHILDREN
Entity Type:Organization
Organization Name:EAST BAY AGENCY FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT SERVICES SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-844-5369
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:510-268-3770
Mailing Address - Fax:510-268-1073
Practice Address - Street 1:520 JEFFERSON ST
Practice Address - Street 2:BOWMAN
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4126
Practice Address - Country:US
Practice Address - Phone:510-268-3770
Practice Address - Fax:510-583-0410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST BAY AGENCY FOR CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-07
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health