Healthcare Provider Details

I. General information

NPI: 1629042833
Provider Name (Legal Business Name): CALIFORNIA-NEVADA METHODIST HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 ALICE ST
OAKLAND CA
94612-4175
US

IV. Provider business mailing address

201 19TH ST SUITE 100
OAKLAND CA
94612-4117
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-5511
  • Fax: 510-273-0529
Mailing address:
  • Phone: 510-893-8989
  • Fax: 510-893-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020000057
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT E HUBBARD
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 510-893-8989