MEDICARE: CITY OF FREMONT

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	:	1194106518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF FREMONT

Provider Business Mailing Address
First Line	:	39155 LIBERTY ST
Second Line	:	SUITE E500
City	:	FREMONT
State	:	CA
Zip	:	94537-5006
Country	:	US
Telephone Number	:	510-574-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	41365 CHAPEL WAY
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4202
Country	:	US
Telephone Number	:	510-656-4000
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. ANNIE BAILEY
Credential	:	M.S., M.P.A., LMFT
Telephone Number	:	510-574-2100

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	11/17/2017

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Directions to “CITY OF FREMONT ” Practice Location

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