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NPI Code Detail

MEDICARE: ROOSEVELT SCHOOL-BASED BEHAVIORAL HEALTH

MEDICARE: ROOSEVELT SCHOOL-BASED BEHAVIORAL HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)
2261QM0855XAdolescent and Children Mental Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101QQ1OTHERCAALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES

General Provider Information

NPI Number : 1003340738
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOSEVELT SCHOOL-BASED BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : PO BOX 22210
Second Line :
City : OAKLAND
State : CA
Zip : 94623-2210
Country : US
Telephone Number : 510-535-4000
Fax Number : 510-535-4189
Provider Business Practice Location Address
First Line : 1926 E 19TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94606-4126
Country : US
Telephone Number : 510-535-4000
Fax Number :
Authorized Official
Title or Position : CEO
Name : JANE GARCIA
Credential :
Telephone Number : 510-535-4000
Provider Enumeration Date : 04/19/2017
Last Update Date : 07/21/2022

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Directions to “ROOSEVELT SCHOOL-BASED BEHAVIORAL HEALTH ” Practice Location

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