Healthcare Provider Details

I. General information

NPI: 1609867746
Provider Name (Legal Business Name): SALEM LUTHERAN HOME ASSOCIATION OF THE BAY CITIES
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

2361 E 29TH ST
OAKLAND CA
94606-3511
US

IV. Provider business mailing address

2361 E 29TH ST
OAKLAND CA
94606-3511
US

V. Phone/Fax

Practice location:
  • Phone: 510-534-3637
  • Fax: 510-537-0851
Mailing address:
  • Phone: 510-534-3637
  • Fax: 510-537-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020000442
License Number StateCA

VIII. Authorized Official

Name: JESSE JANTZEN
Title or Position: CEO
Credential:
Phone: 510-769-2700