Healthcare Provider Details

I. General information

NPI: 1043358542
Provider Name (Legal Business Name): ALTA BATES SUMMIT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HAWTHORNE AVE
OAKLAND CA
94609-3108
US

IV. Provider business mailing address

PO BOX 742920
LOS ANGELES CA
90074-2920
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-8850
  • Fax:
Mailing address:
  • Phone: 855-398-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number140000232
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateCA

VIII. Authorized Official

Name: JOHN GATES
Title or Position: CFO SHBA
Credential:
Phone: 510-450-7357