Provider Demographics
NPI:1710329941
Name:AAIHEALTHSERVICE
Entity Type:Organization
Organization Name:AAIHEALTHSERVICE
Other - Org Name:SALVATION ARMY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:510-521-6078
Mailing Address - Street 1:3550 CEASAR CHAVES STR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:510-521-6078
Mailing Address - Fax:510-521-6079
Practice Address - Street 1:1002 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2306
Practice Address - Country:US
Practice Address - Phone:510-521-6078
Practice Address - Fax:510-521-6079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALVATION ARMY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN4194700261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service