MEDICARE: EAST BAY AGENCY FOR CHILDREN

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	:	1902243462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST BAY AGENCY FOR CHILDREN

Provider Business Mailing Address
First Line	:	303 VAN BUREN AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-4340
Country	:	US
Telephone Number	:	510-268-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	27000 TYRRELL AVE
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94544-3826
Country	:	US
Telephone Number	:	510-268-3770
Fax Number	:

Authorized Official
Title or Position	:	CLIENT SERVICE SPECIALIST
Name	:	CATHERINE HAYNES
Credential	:
Telephone Number	:	510-844-5369

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	09/18/2018

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