Healthcare Provider Details

I. General information

NPI: 1699720862
Provider Name (Legal Business Name): BAYWOOD COURT SKILLED NURSING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20103 LAKE CHABOT RD
CASTRO VALLEY CA
94546-5341
US

IV. Provider business mailing address

3012 SUMMIT ST
OAKLAND CA
94609-3480
US

V. Phone/Fax

Practice location:
  • Phone: 510-727-8290
  • Fax: 510-582-1730
Mailing address:
  • Phone: 510-869-6591
  • Fax: 510-869-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number140000030
License Number StateCA

VIII. Authorized Official

Name: MR. GEORGE DERBEDROSIAN
Title or Position: REGIONAL DIRECTOR - PFS
Credential:
Phone: 510-869-6163