Provider Demographics
NPI:1699100065
Name:EAST BAY AGENCY FOR CHILDREN
Entity type:Organization
Organization Name:EAST BAY AGENCY FOR CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CQI ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:510-844-5368
Mailing Address - Street 1:2828 FORD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2114
Mailing Address - Country:US
Mailing Address - Phone:510-268-3770
Mailing Address - Fax:
Practice Address - Street 1:6701 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-3501
Practice Address - Country:US
Practice Address - Phone:510-918-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST BAY AGENCEY FOR CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-04
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health