Provider Demographics
NPI:1508172842
Name:MISSION AREA HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:MISSION AREA HEALTH ASSOCIATES
Other - Org Name:MISSION NEIGHBORHOOD HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:415-552-3870
Mailing Address - Street 1:240 SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1323
Mailing Address - Country:US
Mailing Address - Phone:415-552-3870
Mailing Address - Fax:415-431-3178
Practice Address - Street 1:165 CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1209
Practice Address - Country:US
Practice Address - Phone:415-869-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)