Healthcare Provider Details

I. General information

NPI: 1174980338
Provider Name (Legal Business Name): WATERMARK BAYSIDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 40TH ST
EMERYVILLE CA
94608-3552
US

IV. Provider business mailing address

2020 W RUDASILL RD
TUCSON AZ
85704-7800
US

V. Phone/Fax

Practice location:
  • Phone: 510-594-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: GRETA FRAZIER
Title or Position: DIRECTOR
Credential:
Phone: 520-797-4000