Healthcare Provider Details

I. General information

NPI: 1114053220
Provider Name (Legal Business Name): SAN MATEO CONVALESCENT HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 N SAN MATEO DR
SAN MATEO CA
94401-2453
US

IV. Provider business mailing address

453 N SAN MATEO DR
SAN MATEO CA
94401-2453
US

V. Phone/Fax

Practice location:
  • Phone: 650-342-6255
  • Fax: 650-342-4812
Mailing address:
  • Phone: 650-342-6255
  • Fax: 650-342-4812

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: MS. PATRICIA A BARNES
Title or Position: ADMINISTRATOR
Credential:
Phone: 650-342-6255