Healthcare Provider Details

I. General information

NPI: 1184791998
Provider Name (Legal Business Name): BAY AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MOWRY AVENUE SUITE A&B&D&F&N
FREMONT CA
94538-1436
US

IV. Provider business mailing address

40910 FREMONT BLVD
FREMONT CA
94538-4375
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax: 510-623-8926
Mailing address:
  • Phone: 510-770-8040
  • Fax: 510-623-8926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number550000139
License Number StateCA

VIII. Authorized Official

Name: NAVNEET BAINS
Title or Position: DEPUTY DIRECTOR OF CLIENT SERVICES
Credential:
Phone: 916-419-7292