Healthcare Provider Details

I. General information

NPI: 1689063489
Provider Name (Legal Business Name): ST ANTHONY SERENETHOS SNF,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 SMALLEY AVE
HAYWARD CA
94541-4919
US

IV. Provider business mailing address

553 SMALLEY AVE
HAYWARD CA
94541-4919
US

V. Phone/Fax

Practice location:
  • Phone: 510-733-3877
  • Fax: 510-446-8631
Mailing address:
  • Phone: 510-733-3877
  • Fax: 510-446-8631

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: QING XIE
Title or Position: CEO
Credential:
Phone: 151-073-3387