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General NPI Number Information
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NPI Number | 1942424106
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Entity Type | Organization
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Legal Business Name | BAY AREA COMMUNITY HEALTH
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/16/2020
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Provider Practice Location Address
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Address Line | 39500 LIBERTY STREET
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City | FREMONT
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State | CA
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Zip | 94538-2211
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Country | US
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Telephone | 510-770-8040
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Fax | 510-623-8926
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Provider Business Mailing Address
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Address Line | 40910 FREMONT BLVD
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City | FREMONT
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State | CA
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Zip | 94538-4375
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Country | US
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Telephone | 510-770-8040
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Fax | 510-623-8926
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Authorized Official
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Title or Position | CEO
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Name | DR. ZETTIE D PAGE III
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Credential | MD, PH.D, MBA. MSW,
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Telephone | 510-252-6811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 140000586
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License Number State | CA
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