Basic Information
| Provider Information | |||||||||
| NPI: | 1558693622 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MISSION AREA HEALTH ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MISSION NEIGHBORHOOD HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 SHOTWELL ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941101390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155523870 | ||||||||
| FaxNumber: | 4154313178 | ||||||||
| Practice Location | |||||||||
| Address1: | 1647 VALENCIA ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941105012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156473666 | ||||||||
| FaxNumber: | 4154313178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2010 | ||||||||
| LastUpdateDate: | 03/25/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STOREY | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4155523870 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MISSION AREA HEALTH ASSOCIATES | ||||||||
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| AuthorizedOfficialCredential: | MSW, LCSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | 550001297 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.