Healthcare Provider Details

I. General information

NPI: 1770657561
Provider Name (Legal Business Name): KAISER FOUNDATION HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 168TH AVE
SAN LEANDRO CA
94578-2409
US

IV. Provider business mailing address

1440 168TH AVE
SAN LEANDRO CA
94578-2409
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-8575
  • Fax:
Mailing address:
  • Phone: 510-481-8575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020000084
License Number StateCA

VIII. Authorized Official

Name: STANLEY R JONES
Title or Position: REGIONAL ADMINISTRATOR
Credential:
Phone: 510-987-2213