Healthcare Provider Details

I. General information

NPI: 1720940810
Provider Name (Legal Business Name): BAY ELDERS INDEPENDENCE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5714 MARTIN LUTHER KING JR WAY
OAKLAND CA
94609-1673
US

IV. Provider business mailing address

630 58TH ST
OAKLAND CA
94609-1412
US

V. Phone/Fax

Practice location:
  • Phone: 510-469-1409
  • Fax: 510-654-4209
Mailing address:
  • Phone: 510-469-1409
  • Fax: 510-654-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAKDA YAPHET
Title or Position: CEO
Credential:
Phone: 510-469-4741