Healthcare Provider Details

I. General information

NPI: 1891146593
Provider Name (Legal Business Name): PRINCETON MANOR HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 57TH AVE
OAKLAND CA
94621-4322
US

IV. Provider business mailing address

2124 57TH AVE
OAKLAND CA
94621-4322
US

V. Phone/Fax

Practice location:
  • Phone: 510-261-2628
  • Fax:
Mailing address:
  • Phone: 510-261-2628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID SILVER
Title or Position: MANAGING MEMBER
Credential:
Phone: 310-896-7471