Healthcare Provider Details

I. General information

NPI: 1740309103
Provider Name (Legal Business Name): 3555 CEASAR CHAVEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CESAR CHAVEZ
SAN FRANCISCO CA
94110-4403
US

IV. Provider business mailing address

3555 CESAR CHAVEZ
SAN FRANCISCO CA
94110-4403
US

V. Phone/Fax

Practice location:
  • Phone: 415-647-8600
  • Fax:
Mailing address:
  • Phone: 415-647-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000070
License Number StateCA

VIII. Authorized Official

Name: MICHAEL P. HOLDSWORTH
Title or Position: VICE PRESIDENT OF ADMIN CFO
Credential:
Phone: 415-600-3959