MEDICARE: BAYVIEW HUNTERS POINT

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1942532544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYVIEW HUNTERS POINT

Provider Business Mailing Address
First Line	:	150 EXECUTIVE PARK BLVD STE 2800
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94134-3311
Country	:	US
Telephone Number	:	415-468-5100
Fax Number	:	415-468-5104

Provider Business Practice Location Address
First Line	:	1618 REVERE AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94124-2304
Country	:	US
Telephone Number	:	415-920-7030
Fax Number	:	415-920-1720

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JACOB K. MOODY
Credential	:	MSW
Telephone Number	:	415-468-5100

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/05/2010

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Directions to “BAYVIEW HUNTERS POINT ” Practice Location

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