Healthcare Provider Details

I. General information

NPI: 1801277223
Provider Name (Legal Business Name): CITY OF FREMONT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41717 PALM AVE
FREMONT CA
94539-4722
US

IV. Provider business mailing address

PO BOX 5006
FREMONT CA
94537-5006
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-3600
  • Fax:
Mailing address:
  • Phone: 510-547-2100
  • 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: MS. ANNIE BAILEY
Title or Position: ADMINISTRATOR
Credential: M.S., M.P.A., LMFT
Phone: 510-547-2100