1659461408 NPI number — ST. THERESE CONVALESCENT HOSPITAL ,INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659461408 NPI number — ST. THERESE CONVALESCENT HOSPITAL ,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. THERESE CONVALESCENT HOSPITAL ,INC.
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:
1659461408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3635 JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDWOOD CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94062-3148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-366-0294
Provider Business Mailing Address Fax Number:
650-366-0295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3635 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94062-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-366-0294
Provider Business Practice Location Address Fax Number:
650-366-0295
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CABANAYAN
Authorized Official First Name:
DANILO
Authorized Official Middle Name:
CARDENAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
650-366-0294

Provider Taxonomy Codes

  • Taxonomy code: 3140N1450X , 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: LTC55813F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com