Healthcare Provider Details

I. General information

NPI: 1417217571
Provider Name (Legal Business Name): BAY AREA JEWISH SENIOR LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 TROUSDALE DR
BURLINGAME CA
94010-4520
US

IV. Provider business mailing address

302 SILVER AVE
SAN FRANCISCO CA
94112-1510
US

V. Phone/Fax

Practice location:
  • Phone: 415-562-2680
  • Fax:
Mailing address:
  • Phone: 415-562-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DANIEL R. RUTH
Title or Position: PRESIDENT
Credential:
Phone: 415-562-2680