Healthcare Provider Details

I. General information

NPI: 1013904267
Provider Name (Legal Business Name): THE WATERS EDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BLANDING AVE
ALAMEDA CA
94501-1503
US

IV. Provider business mailing address

2401 BLANDING AVE
ALAMEDA CA
94501-1503
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-1084
  • Fax: 510-748-4289
Mailing address:
  • Phone: 510-522-1084
  • Fax: 510-748-4289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. LYNN MUSERELLI
Title or Position: HEALTH INFORMATION MANAGER
Credential:
Phone: 510-522-1084