Provider Demographics
NPI:1558693622
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:94110-1390
Mailing Address - Country:US
Mailing Address - Phone:415-552-3870
Mailing Address - Fax:415-431-3178
Practice Address - Street 1:1647 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5012
Practice Address - Country:US
Practice Address - Phone:415-647-3666
Practice Address - Fax:415-431-3178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION AREA HEALTH ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-01
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001297261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)