Provider Demographics
NPI:1689825366
Name:THE WEST OAKLAND HEALTH COUNCIL
Entity Type:Organization
Organization Name:THE WEST OAKLAND HEALTH COUNCIL
Other - Org Name:WEST OAKLAND HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PETTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-835-9610
Mailing Address - Street 1:2730 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607
Mailing Address - Country:US
Mailing Address - Phone:510-465-1800
Mailing Address - Fax:
Practice Address - Street 1:2730 ADELINE STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:510-468-1800
Practice Address - Fax:510-465-1508
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WEST OAKLAND HEALTH COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-01
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center