Healthcare Provider Details

I. General information

NPI: 1629164686
Provider Name (Legal Business Name): MACARTHUR CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 MACARTHUR BLVD
OAKLAND CA
94610-3233
US

IV. Provider business mailing address

309 MACARTHUR BLVD
OAKLAND CA
94610-3233
US

V. Phone/Fax

Practice location:
  • Phone: 510-836-3777
  • Fax: 510-836-0516
Mailing address:
  • Phone: 510-836-3777
  • Fax: 510-836-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020000061
License Number StateCA

VIII. Authorized Official

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