Healthcare Provider Details

I. General information

NPI: 1235352444
Provider Name (Legal Business Name): THE WEST OAKLAND HEALTH COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 28TH ST
OAKLAND CA
94609-3602
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 Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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