1629242599 NPI number — NAPA SKILLED NURSING CENTER

Table of content: (NPI 1629242599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629242599 NPI number — NAPA SKILLED NURSING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAPA SKILLED NURSING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NAZARETH SKILLED NURSING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629242599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 S B ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94401-4272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-347-9500
Provider Business Mailing Address Fax Number:
650-347-9400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2465 REDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94558-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-255-3012
Provider Business Practice Location Address Fax Number:
707-255-1015
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HANHAN
Authorized Official First Name:
HANNA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
650-347-9500

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZR05549K , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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