Healthcare Provider Details

I. General information

NPI: 1790850329
Provider Name (Legal Business Name): SAN LEANDRO HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 JUANA AVE
SAN LEANDRO CA
94577-0000
US

IV. Provider business mailing address

524 CALLAN AVE
SAN LEANDRO CA
94577-0000
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-4015
  • Fax: 510-357-3466
Mailing address:
  • Phone: 510-352-3402
  • Fax: 510-352-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number02 0000097
License Number StateCA

VIII. Authorized Official

Name: PAT PODDATOORI
Title or Position: OWNER
Credential:
Phone: 310-386-3340