MEDICARE: RICHMOND POST ACUTE CARE, LLC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140000141	OTHER	CA	CDPH LICENSE NUMBER

General Provider Information

NPI Number	:	1821557620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND POST ACUTE CARE, LLC.

Provider Business Mailing Address
First Line	:	955 23RD ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 23RD ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1250
Country	:	US
Telephone Number	:	510-237-5182
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DARRELL PRICE
Credential	:
Telephone Number	:	916-212-0275

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	08/10/2020

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