=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215886494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HABITAT HEALTH SAN LEANDRO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2026
-----------------------------------------------------
Last Update Date | 01/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2420 MERCED STREET
-----------------------------------------------------
City | SAN LEANDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-664-2248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 ARKANSAS ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94107-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-664-2248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MATTHEW BENNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 844-664-2248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251T00000X
-----------------------------------------------------
Taxonomy Name | PACE Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------