Healthcare Provider Details

I. General information

NPI: 1912996349
Provider Name (Legal Business Name): ST MICHAEL CONVALESCENT HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25919 GADING RD
HAYWARD CA
94544-2725
US

IV. Provider business mailing address

25919 GADING RD
HAYWARD CA
94544-2725
US

V. Phone/Fax

Practice location:
  • Phone: 510-782-3825
  • Fax: 510-782-8793
Mailing address:
  • Phone: 510-782-3825
  • Fax: 510-782-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number760077117
License Number StateCA

VIII. Authorized Official

Name: MRS. SALLY JANE RAPP
Title or Position: DIRECTOR
Credential:
Phone: 510-782-3825