Healthcare Provider Details

I. General information

NPI: 1245141530
Provider Name (Legal Business Name): EAST BAY LONGEVITY ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 12TH ST
OAKLAND CA
94607-4249
US

IV. Provider business mailing address

1086 CLEARFIELD DR
MILLBRAE CA
94030-2153
US

V. Phone/Fax

Practice location:
  • Phone: 510-808-7783
  • Fax: 510-255-6089
Mailing address:
  • Phone: 415-218-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICE KUANG
Title or Position: ADMINISTRATOR
Credential:
Phone: 415-218-2620