Healthcare Provider Details

I. General information

NPI: 1568840387
Provider Name (Legal Business Name): BAY AREA COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3607 MAIN ST SUITE 3B
FREMONT CA
94538-4390
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 TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number550002016
License Number StateCA

VIII. Authorized Official

Name: MR. ZETTIE D PAGE III
Title or Position: CEO
Credential: M.D., PH.D, MBA, MSW
Phone: 510-252-6811