Healthcare Provider Details

I. General information

NPI: 1639324478
Provider Name (Legal Business Name): CALIFORNIA NEVADA METHODIST HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 GIBSON AVE
PACIFIC GROVE CA
93950-4330
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 831-657-5200
  • Fax: 831-649-1695
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 Number550001102
License Number StateCA

VIII. Authorized Official

Name: ROBERT HUBBARD
Title or Position: PRESIDENT
Credential:
Phone: 510-893-8989