=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972026672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALZHEIMER'S SERVICES OF THE EAST BAY, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43326 MISSION BLVD STE 9
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94539-5829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-656-1329
-----------------------------------------------------
Fax | 510-656-1418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2320 CHANNING WAY
-----------------------------------------------------
City | BERKELEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94704-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-644-8292
-----------------------------------------------------
Fax | 510-540-6771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CE
-----------------------------------------------------
Name | MS. MICHEAL POPE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-644-8292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 550003551
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------