Healthcare Provider Details

I. General information

NPI: 1982841938
Provider Name (Legal Business Name): THE WEST OAKLAND HEALTH COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 TELEGRAPH AVE # B OPTIONS FOR RECOVERY
OAKLAND CA
94609-3205
US

IV. Provider business mailing address

700 ADELINE ST
OAKLAND CA
94607-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-273-4900
  • Fax:
Mailing address:
  • Phone: 510-835-9610
  • Fax: 510-272-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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