Healthcare Provider Details

I. General information

NPI: 1639431471
Provider Name (Legal Business Name): COMPREHENSIVE CARE OF OAKLAND LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 10TH AVE
OAKLAND CA
94606-3023
US

IV. Provider business mailing address

1833 10TH AVE
OAKLAND CA
94606-3023
US

V. Phone/Fax

Practice location:
  • Phone: 510-536-6512
  • Fax:
Mailing address:
  • Phone: 510-536-6512
  • Fax: 510-536-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number02000033
License Number StateCA

VIII. Authorized Official

Name: SHIRLEY MA
Title or Position: CEO
Credential:
Phone: 510-536-6512