Provider Demographics
NPI:1881632867
Name:COUNTY OF ALAMEDA
Entity Type:Organization
Organization Name:COUNTY OF ALAMEDA
Other - Org Name:ALAMEDA COUNTY HEATH CARE FOR THE HOMELESS
Other - Org Type:Other Name
Authorized Official - Title/Position:GRANTS MGR AO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MODERSBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-891-8916
Mailing Address - Street 1:1404 FRANKLIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3208
Mailing Address - Country:US
Mailing Address - Phone:510-891-8950
Mailing Address - Fax:510-273-3802
Practice Address - Street 1:384 14TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3211
Practice Address - Country:US
Practice Address - Phone:510-891-8950
Practice Address - Fax:510-273-3802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ALAMEDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051058Medicare PIN