Healthcare Provider Details

I. General information

NPI: 1538356795
Provider Name (Legal Business Name): CASTRO VALLEY HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20259 LAKE CHABOT RD
CASTRO VALLEY CA
94546-5307
US

IV. Provider business mailing address

524 CALLAN AVE
SAN LEANDRO CA
94577-4610
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-3402
  • Fax: 510-352-8530
Mailing address:
  • Phone: 510-352-3402
  • Fax: 510-352-8530

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. PRATAP PODDATOORI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 510-352-3402