Provider Demographics
NPI:1659770873
Name:BAY AREA COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:BAY AREA COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, QUALITY IMPROVEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-318-6135
Mailing Address - Street 1:1814 FRANKLIN ST FL 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3487
Mailing Address - Country:US
Mailing Address - Phone:510-613-0330
Mailing Address - Fax:
Practice Address - Street 1:236 GEORGIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5991
Practice Address - Country:US
Practice Address - Phone:510-613-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1539251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01L2Medicaid
CA81951Medicaid
CA01L2Medicaid