MEDICARE: BAY AREA COMMUNITY RESOURCES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003462987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA COMMUNITY RESOURCES, INC

Provider Business Mailing Address
First Line	:	11175 SAN PABLO AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2157
Country	:	US
Telephone Number	:	510-559-3009
Fax Number	:	510-559-3069

Provider Business Practice Location Address
First Line	:	1231 18TH ST
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94806-4703
Country	:	US
Telephone Number	:	510-231-1435
Fax Number	:	510-233-8961

Authorized Official
Title or Position	:	CHIEF PROGRAM OFFICER
Name	:	DONALD BRUCE BLASKY
Credential	:
Telephone Number	:	415-755-2311

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	08/02/2021

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