Provider Demographics
NPI:1497192900
Name:CHILDREN'S HOSPITAL RESEARCH CENTER OAKLAND
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL RESEARCH CENTER OAKLAND
Other - Org Name:CHAPPELL HAYES HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISCOE-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-428-3885
Mailing Address - Street 1:2607 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3415
Mailing Address - Country:US
Mailing Address - Phone:510-835-1393
Mailing Address - Fax:510-835-2497
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN' HOSPIAL RESEARCH CENTER OAKLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)