Healthcare Provider Details

I. General information

NPI: 1225029366
Provider Name (Legal Business Name): MERCY RETIREMENT AND CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 FOOTHILL BLVD
OAKLAND CA
94601-3129
US

IV. Provider business mailing address

3431 FOOTHILL BLVD
OAKLAND CA
94601-3129
US

V. Phone/Fax

Practice location:
  • Phone: 510-534-8540
  • Fax: 510-261-4516
Mailing address:
  • Phone: 510-534-8540
  • Fax: 510-261-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020000237
License Number StateCA

VIII. Authorized Official

Name: MS. ADRIENE IVERSON
Title or Position: CEO
Credential:
Phone: 510-769-2700