Healthcare Provider Details

I. General information

NPI: 1376473405
Provider Name (Legal Business Name): DOUBLE PINE CARE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 GRANADA CT
PINOLE CA
94564-1812
US

IV. Provider business mailing address

2359 GRANADA CT
PINOLE CA
94564-1812
US

V. Phone/Fax

Practice location:
  • Phone: 510-758-9888
  • Fax: 510-275-3080
Mailing address:
  • Phone: 510-229-2209
  • Fax: 510-275-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MR. FEI LI
Title or Position: MANAGER
Credential:
Phone: 510-758-9888