Healthcare Provider Details

I. General information

NPI: 1659770873
Provider Name (Legal Business Name): BAY AREA COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 GEORGIA ST SUITE 101
VALLEJO CA
94590-5991
US

IV. Provider business mailing address

1814 FRANKLIN ST FL 4
OAKLAND CA
94612-3487
US

V. Phone/Fax

Practice location:
  • Phone: 510-613-0330
  • Fax:
Mailing address:
  • Phone: 510-613-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1539
License Number StateCA

VIII. Authorized Official

Name: MS. SAMANTHA MARIE FRYER
Title or Position: SR. DIRECTOR, QUALITY IMPROVEMENT
Credential:
Phone: 510-318-6135