Healthcare Provider Details

I. General information

NPI: 1306932322
Provider Name (Legal Business Name): TRINITY OAKLAND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 HIGH ST
OAKLAND CA
94619-1839
US

IV. Provider business mailing address

3145 HIGH ST
OAKLAND CA
94619-1839
US

V. Phone/Fax

Practice location:
  • Phone: 510-533-9970
  • Fax: 510-533-5488
Mailing address:
  • Phone: 510-533-9970
  • Fax: 510-533-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020000045
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RANDAL KLEIS
Title or Position: PRESIDENT
Credential:
Phone: 425-820-9750