Healthcare Provider Details

I. General information

NPI: 1053309401
Provider Name (Legal Business Name): RCC FACILITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 40TH STREET WAY
OAKLAND CA
94611-5612
US

IV. Provider business mailing address

210 40TH STREET WAY
OAKLAND CA
94611-5612
US

V. Phone/Fax

Practice location:
  • Phone: 510-658-2041
  • Fax: 510-658-3108
Mailing address:
  • Phone: 510-658-2041
  • Fax: 510-658-3108

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: SUZETTE CHEATHAM
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 510-658-2041