Provider Demographics
NPI:1972026672
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:CE
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 1:43326 MISSION BLVD STE 9
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5829
Practice Address - Country:US
Practice Address - Phone:510-656-1329
Practice Address - Fax:510-656-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550003551261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid