Provider Demographics
NPI:1558742973
Name:CITY OF FREMONT
Entity Type:Organization
Organization Name:CITY OF FREMONT
Other - Org Name:MATTOS ELEMENTARY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPA, LMFT
Authorized Official - Phone:510-547-2100
Mailing Address - Street 1:39155 LIBERTY ST
Mailing Address - Street 2:SUITE E500
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94537-5006
Mailing Address - Country:US
Mailing Address - Phone:510-574-2100
Mailing Address - Fax:
Practice Address - Street 1:37944 FARWELL DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-7008
Practice Address - Country:US
Practice Address - Phone:510-793-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health