Healthcare Provider Details

I. General information

NPI: 1164973491
Provider Name (Legal Business Name): THE WEST OAKLAND HEALTH COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 FONTAINE ST
OAKLAND CA
94605-4109
US

IV. Provider business mailing address

7501 INTERNATIONAL BLVD
OAKLAND CA
94621-2843
US

V. Phone/Fax

Practice location:
  • Phone: 510-636-7992
  • Fax:
Mailing address:
  • Phone: 510-729-8800
  • Fax: 510-569-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BENJAMIN F. PETTUS
Title or Position: CEO
Credential:
Phone: 510-835-9610