| Fred Finch Youth Center | |
|
3800 Coolidge Ave Oakland CA 94602-3311 | |
| (510) 482-2244 | |
| (510) 488-1960 |
| Full Name | Fred Finch Youth Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3800 Coolidge Ave, Oakland, California |
| Authorized Official Name and Position | Thomas N Alexander (PRESIDENT AND CEO) |
| Authorized Official Contact | 5104822244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fred Finch Youth Center 3800 Coolidge Ave Oakland CA 94602-3311 Ph: (510) 482-2244 | Fred Finch Youth Center 3800 Coolidge Ave Oakland CA 94602-3311 Ph: (510) 482-2244 |
| NPI Number | 1316009558 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 07/28/2022 |
| Certification Date | 07/28/2022 |
| Medicare PECOS PAC ID | 4486809381 |
|---|---|
| Medicare Enrollment ID | O20130226000326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316009558 | NPI | - | NPPES |
| 01260208 | Medicaid | CA | |
| 01870808 | Medicaid | CA | |
| 00G503291 | Other | CA | PROVIDER ID |
| 00113 | Other | CA | LEGAL ENTITY NUMBER |
| 01761908 | Medicaid | CA |
| Provider Name | Megan O'brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750784559 PECOS PAC ID: 2668758160 Enrollment ID: I20170418001552 |
| Provider Name | Colette Warden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497137749 PECOS PAC ID: 2264854587 Enrollment ID: I20200615002387 |
| Provider Name | Funmilola Umoren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124665468 PECOS PAC ID: 1254744048 Enrollment ID: I20210118000180 |
| Provider Name | Regina Nicole Cantrell-kinzfogl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598159154 PECOS PAC ID: 5496134975 Enrollment ID: I20220614002791 |
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