Healthcare Provider Details

I. General information

NPI: 1942620083
Provider Name (Legal Business Name): CREEKVIEW HC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 STONERIDGE DRIVE
PLEASANTON CA
94588-2200
US

IV. Provider business mailing address

2900 STONERIDGE DRIVE
PLEASANTON CA
94588-2200
US

V. Phone/Fax

Practice location:
  • Phone: 925-201-4000
  • Fax: 925-249-9435
Mailing address:
  • Phone: 925-201-4000
  • Fax: 925-249-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550003252
License Number StateCA

VIII. Authorized Official

Name: MR. TROY A. BOURNE
Title or Position: MANAGER
Credential:
Phone: 925-227-6802