Provider Demographics
NPI:1538501911
Name:GIRLS INCORPORATED OF ALAMEDA COUNTY
Entity Type:Organization
Organization Name:GIRLS INCORPORATED OF ALAMEDA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOESSENECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-357-5515
Mailing Address - Street 1:510 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1520
Mailing Address - Country:US
Mailing Address - Phone:510-357-5515
Mailing Address - Fax:510-318-5396
Practice Address - Street 1:510 16TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1520
Practice Address - Country:US
Practice Address - Phone:510-357-5515
Practice Address - Fax:510-318-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22806ZMedicare PIN