Healthcare Provider Details

I. General information

NPI: 1952113458
Provider Name (Legal Business Name): BAY AREA MARANATHA CHRISTIAN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 S 7TH ST
SAN JOSE CA
95112-6074
US

IV. Provider business mailing address

1811 S 7TH ST
SAN JOSE CA
95112-6074
US

V. Phone/Fax

Practice location:
  • Phone: 408-280-7292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TYRONE PARTEE
Title or Position: SENIOR PASTOR/CEO
Credential: DMIN
Phone: 669-270-9369