Provider Demographics
NPI:1609249994
Name:AXIS COMMUNITY HEALTH INC
Entity Type:Organization
Organization Name:AXIS COMMUNITY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-462-1755
Mailing Address - Street 1:5925 W LAS POSITAS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8537
Mailing Address - Country:US
Mailing Address - Phone:925-462-1755
Mailing Address - Fax:925-417-1503
Practice Address - Street 1:5925 W LAS POSITAS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8537
Practice Address - Country:US
Practice Address - Phone:925-462-1755
Practice Address - Fax:925-417-1503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXIS COMMUNITY HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-09
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70205FMedicaid
CAFHC11593FMedicaid
CAFHC11593FMedicaid
CA551090Medicare PIN
CAFHC11593FMedicaid