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General NPI Number Information
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NPI Number | 1952113458
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Entity Type | Organization
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Legal Business Name | BAY AREA MARANATHA CHRISTIAN CENTER
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 1811 S 7TH ST
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City | SAN JOSE
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State | CA
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Zip | 95112-6074
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Country | US
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Telephone | 408-280-7292
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 S 7TH ST
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City | SAN JOSE
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State | CA
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Zip | 95112-6074
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SENIOR PASTOR/CEO
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Name | DR. TYRONE PARTEE
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Credential | DMIN
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Telephone | 669-270-9369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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