Healthcare Provider Details

I. General information

NPI: 1083606115
Provider Name (Legal Business Name): INDEPENDENT QUALITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 DENTON AVE
HAYWARD CA
94545-1943
US

IV. Provider business mailing address

3 CROW CANYON CT
SAN RAMON CA
94583-1966
US

V. Phone/Fax

Practice location:
  • Phone: 510-782-2133
  • Fax: 516-783-3659
Mailing address:
  • Phone: 925-855-0881
  • Fax: 925-855-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEREMY E GRIMES
Title or Position: MANAGER
Credential:
Phone: 925-855-0881