1629042833 NPI number — CALIFORNIA-NEVADA METHODIST HOMES

Table of content: (NPI 1629042833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629042833 NPI number — CALIFORNIA-NEVADA METHODIST HOMES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA-NEVADA METHODIST HOMES
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:
Provider Other Organization Name Type Code:
6
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:
1629042833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 19TH ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94612-4117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-893-8989
Provider Business Mailing Address Fax Number:
510-893-3041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 ALICE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-4175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-835-5511
Provider Business Practice Location Address Fax Number:
510-273-0529
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBARD
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
510-893-8989

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  020000057 , 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)





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