Healthcare Provider Details

I. General information

NPI: 1336586890
Provider Name (Legal Business Name): EAST BAY AGENCY FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40292 LESLIE ST
FREMONT CA
94538-3520
US

IV. Provider business mailing address

2828 FORD ST
OAKLAND CA
94601-2114
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-3770
  • Fax:
Mailing address:
  • Phone: 510-268-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE HAYNES
Title or Position: CLIENT SEERVICE SPECIALIST
Credential:
Phone: 510-844-5369