MEDICARE: BAY AREA COMMUNITY HEALTH

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	171M00000X	Case Manager/Care Coordinator
2	261QF0400X	Federally Qualified Health Center (FQHC)		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	550003720	OTHER	CA	LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780054379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	40910 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4375
Country	:	US
Telephone Number	:	510-252-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	40910 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4375
Country	:	US
Telephone Number	:	510-770-8133
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ZETTIE D PAGE III
Credential	:
Telephone Number	:	510-623-8926

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	02/02/2022

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Directions to “BAY AREA COMMUNITY HEALTH ” Practice Location

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