Provider Demographics
NPI:1891235859
Name:ALZHEIMER'S SERVICES OF THE EAST BAY, INCORPORATED
Entity Type:Organization
Organization Name:ALZHEIMER'S SERVICES OF THE EAST BAY, INCORPORATED
Other - Org Name:ASEB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-644-8292
Mailing Address - Street 1:2320 CHANNING WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2202
Mailing Address - Country:US
Mailing Address - Phone:510-644-8292
Mailing Address - Fax:510-540-6771
Practice Address - Street 1:1105 WALPERT STREET
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-888-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000512261QA0600X
CA070000508261QA0600X
CA550003551261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550003551OtherSTATE OF CALIFORNIA-DEPARTMENT OF PUBLIC HEALTH
CA070000508OtherSTATE OF CALIFORNIA-DEPARTMENT OF PUBLIC HEALTH
CA070000512OtherSTATE OF CALIFORNIA-DEPARTMENT OF PUBLIC HEALTH