Healthcare Provider Details

I. General information

NPI: 1821828625
Provider Name (Legal Business Name): SUMMERVILLE AT COBBCO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18888 BOLLINGER CANYON RD
SAN RAMON CA
94583-5329
US

IV. Provider business mailing address

18888 BOLLINGER CANYON RD
SAN RAMON CA
94583-5329
US

V. Phone/Fax

Practice location:
  • Phone: 925-831-3964
  • Fax:
Mailing address:
  • Phone: 925-831-3964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNA MUNOZ
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 414-918-5443