Provider Demographics
NPI:1184791998
Name:BAY AREA COMMUNITY HEALTH
Entity type:Organization
Organization Name:BAY AREA COMMUNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR OF CLIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NAVNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:BAINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-419-7292
Mailing Address - Street 1:40910 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4375
Mailing Address - Country:US
Mailing Address - Phone:510-770-8040
Mailing Address - Fax:510-623-8926
Practice Address - Street 1:1999 MOWRY AVENUE SUITE A&B&D&F&N
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1436
Practice Address - Country:US
Practice Address - Phone:510-770-8040
Practice Address - Fax:510-623-8926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY AREA COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA550000139261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71115FMedicaid
CA550000139OtherCOMMUNITY CLINIC LICENSE
CAFHC71115FMedicaid