Healthcare Provider Details

I. General information

NPI: 1952393076
Provider Name (Legal Business Name): ST JOHNS VOLUNTEERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 FLORES ST
SAN MATEO CA
94403-2320
US

IV. Provider business mailing address

5000 EXECUTIVE PKWY SUITE 150
SAN RAMON CA
94583-4210
US

V. Phone/Fax

Practice location:
  • Phone: 650-349-2161
  • Fax: 650-349-4510
Mailing address:
  • Phone: 925-855-0881
  • Fax: 925-855-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number220000171
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number220000171
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number220000171
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000171
License Number StateCA

VIII. Authorized Official

Name: JEREMY E GRIMES
Title or Position: MANAGER
Credential:
Phone: 925-855-0881