Provider Demographics
NPI:1801060637
Name:BROOKSIDE COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:BROOKSIDE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKJAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-215-9092
Mailing Address - Street 1:2023 VALE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3834
Mailing Address - Country:US
Mailing Address - Phone:510-215-9092
Mailing Address - Fax:510-215-0362
Practice Address - Street 1:2023 VALE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3834
Practice Address - Country:US
Practice Address - Phone:510-215-9092
Practice Address - Fax:510-215-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0001779261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care