Healthcare Provider Details

I. General information

NPI: 1467597534
Provider Name (Legal Business Name): BANCROFT CONVALESCENT HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 BANCROFT AVE
SAN LEANDRO CA
94577-5105
US

IV. Provider business mailing address

1475 BANCROFT AVE
SAN LEANDRO CA
94577-5105
US

V. Phone/Fax

Practice location:
  • Phone: 510-483-1680
  • Fax: 510-483-1683
Mailing address:
  • Phone: 510-483-1680
  • Fax: 510-483-1683

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: MR. BOYD H MACDONALD
Title or Position: PRESIDENT
Credential:
Phone: 510-483-1680