Provider Demographics
NPI:1558749440
Name:ALAMEDA HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALAMEDA HEALTH SYSTEM
Other - Org Name:AHS HOMELESS MOBILE CLINIC #1
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-618-2147
Mailing Address - Street 1:15400 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1009
Mailing Address - Country:US
Mailing Address - Phone:510-895-7344
Mailing Address - Fax:510-895-7229
Practice Address - Street 1:15400 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3746
Practice Address - Country:US
Practice Address - Phone:510-532-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)