Healthcare Provider Details

I. General information

NPI: 1104932417
Provider Name (Legal Business Name): TY FIVE STAR CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 MONO AVE
SAN LEANDRO CA
94578-2020
US

IV. Provider business mailing address

1652 MONO AVENUE
SAN LEANDRO CA
94578
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-3200
  • Fax: 510-278-7912
Mailing address:
  • Phone: 510-481-3200
  • Fax: 510-278-7912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TOBIAS L YEH
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 510-481-3306