MEDICARE: INDEPENDENT QUALITY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083606115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT QUALITY CARE

Provider Business Mailing Address
First Line	:	3 CROW CANYON CT
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1966
Country	:	US
Telephone Number	:	925-855-0881
Fax Number	:	925-855-9297

Provider Business Practice Location Address
First Line	:	1625 DENTON AVE
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94545-1943
Country	:	US
Telephone Number	:	510-782-2133
Fax Number	:	516-783-3659

Authorized Official
Title or Position	:	MANAGER
Name	:	JEREMY E GRIMES
Credential	:
Telephone Number	:	925-855-0881

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/22/2020

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Directions to “INDEPENDENT QUALITY CARE ” Practice Location

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