Healthcare Provider Details

I. General information

NPI: 1932067584
Provider Name (Legal Business Name): 3230 CARLSON BLVD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 CARLSON BLVD
EL CERRITO CA
94530-3907
US

IV. Provider business mailing address

2305 HISTORIC DECATUR RD STE 100
SAN DIEGO CA
92106-6071
US

V. Phone/Fax

Practice location:
  • Phone: 510-525-3212
  • Fax:
Mailing address:
  • Phone:
  • 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: RICHARD MARTIN
Title or Position: MANAGER
Credential:
Phone: 510-525-3212