| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 417 29th St, Oakland, California |
| Authorized Official Name and Position | Scott Osborn (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 5105200943 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8945 Golf Links Rd Oakland CA 94605-4124 Ph: (510) 317-1444 | 417 29th St Oakland CA 94609-3510 Ph: (510) 317-1444 |
| NPI Number | 1033409214 |
|---|---|
| Provider Enumeration Date | 04/09/2011 |
| Last Update Date | 01/28/2025 |
| Certification Date | 01/28/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033409214 | NPI | - | NPPES |
| 0015 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (California) | Primary |
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