Healthcare Provider Details

I. General information

NPI: 1760471346
Provider Name (Legal Business Name): ST. CHRISTOPHER CONVALESCENT HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22822 MYRTLE ST
HAYWARD CA
94541-6321
US

IV. Provider business mailing address

22822 MYRTLE ST
HAYWARD CA
94541-6321
US

V. Phone/Fax

Practice location:
  • Phone: 510-733-3877
  • Fax: 510-733-3871
Mailing address:
  • Phone: 510-733-3877
  • Fax: 510-733-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020000103
License Number StateCA

VIII. Authorized Official

Name: MRS. MELANIE RAPP
Title or Position: ADMINISTRATOR
Credential:
Phone: 510-733-3877