Healthcare Provider Details

I. General information

NPI: 1720032329
Provider Name (Legal Business Name): CASAVINA FOUNDATION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 ALVIN AVE
SAN JOSE CA
95121-1660
US

IV. Provider business mailing address

2501 ALVIN AVE
SAN JOSE CA
95121-1660
US

V. Phone/Fax

Practice location:
  • Phone: 408-238-9751
  • Fax: 408-238-3905
Mailing address:
  • Phone: 408-238-9751
  • Fax: 408-238-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000265
License Number StateCA

VIII. Authorized Official

Name: JOSH HEDGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-238-9751