Healthcare Provider Details

I. General information

NPI: 1306958731
Provider Name (Legal Business Name): OAKRIDGE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 FRUITVALE AVE
OAKLAND CA
94602-2108
US

IV. Provider business mailing address

1355 WILLOW WAY SUITE 264
CONCORD CA
94520-5723
US

V. Phone/Fax

Practice location:
  • Phone: 510-261-8564
  • Fax: 510-261-0408
Mailing address:
  • Phone: 925-808-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number48118772
License Number StateCA

VIII. Authorized Official

Name: ALBA TILLER
Title or Position: PRESIDENT
Credential:
Phone: 925-808-6540